Purpose: Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis (LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or two following surgery.
Methods: We describe one case of diffuse lamellar keratitis that occurred 3 months after LASIK. The patient developed a spontaneous corneal erosion in one eye. Over the next 2 days while the erosion was being treated, there was rapid development of DLK. Slit-lamp biomicroscopy and in vivo scanning slit confocal microscopy were performed. The patient was treated with intensive topical corticosteroids.
Results: Scanning slit confocal microscopy revealed numerous, highly-reflective round bodies consistent with a polymorphonuclear infiltrate located at the flap interface. Treatment with topical 1.0% prednisolone acetate was instituted, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopy.
Conclusions: Diffuse lamellar keratitis may occur months after LASIK as a result of a spontaneous recurrent corneal epithelial erosion.