Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report

We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS (R) Intra-Lase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. High-dose dexamethasone eyedrops with topical antibiotic and artificial tears were prescribed. Five days after surgery, a central corneal opacity with convergent striae was detected at biomicroscopy. The suspicion of DLK was confirmed. Additional therapy based on hyperosmolar ophthalmological solution, oral doxycycline, and topical 10% sodium citrate was prescribed. Treatment was continued and tapered for over 3 months. Improvement in corneal transparency were obtained 2 weeks after the systemic therapy had been started. Uncorrected visual acuity improved from 20/32 to 20/20 at 1-year follow-up. DLK represents an infrequent complication after femto-LASIK. It should resolve without sequelae if promptly diagnosed and treated, without necessity of corneal flap lifting. (C) 2018 The Author(s) Published by S. Karger AG, Basel