Diffuse Lamellar Keratitis
Ten Years after LASIK
Elena Basli, Barbara Ameline, Jean-
Christophe Gavrilov, Laurent Laroche,
Quinze-Vingts National Hospital, Paris,
All co-authors would like to disclosure
the lack of any financial interest.
To report a case of Diffuse Lamellar
Keratitis (DLK) secondary to bacterial
corneal ulcer, 10 years after LASIK
A 35 years old man with a myopia of - 8
dioptries on both eyes, underwent
uneventful lasik in 1996 on his right eye and
PKR on his left eye.
Undercorrection led him to wear soft contact
lenses after one year.
Ten years later he was referred to us
complaining of pain, blurred vision, foreign
body sensation, and light sensitivity in his
Clinical examination at the
Corrected VA on his right eye : 12 / 60.
Slit lamp examination : ulceration of the
cornea with peripheral infiltrates, punctuate
epithelial keratitis, folds of the Descemet
membrane, secondary anterior uveitis with
Tyndall (+2) and :
Infiltrates of the interface aggregating in the
central visual axis. (Sands of the Sahara
syndrome, Stage 3)
Initial instillation of topical fortified antibiotics
at hourly intervals were applied (Ticarcillin,
Gentamycin and Vancomycin) for the first 3
days, cycloplegics (atropine 1%) and
artificial eye drops
Corneal tissue retrieval, microbiological
analysis of the contact lens, HRT and OCT
Visante were performed
Day 3 : the response to antobiotic therapy was
favourable on the ulcer. Interface didn’t improve. We
therefore initiated topical steroids (conjunctival
injections) on day 3 and reduced the frequency of
antibiotics instillation at 6 times daily.
Day 7 : improvement was confirmed, fortified drops
were substituted for weaker commercial preparation of
Tobramycin, Dexamethasone, Cefuroxim and artificial
Day 15 : VA: 10/10 with -4.50(-2.25)135°, interface
Results of corneal tissue retrieval were negative but
those of the lens were positive for pyocyanic.
DLK can occur not only months but even years,
after surgery in case on an epithelial trauma, loss of
epithelial integrity with or without bacterial
inflammation or disruption of the flap.
Quick diagnosis and treatment are mandatory
Antibacterial treatment associated with aggressive
steroid therapy allow complete recovery
Response to treatment was in this case comparable
to an early Diffuse Lamellar Keratitis (DLK)