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Diffuse Lamellar Keratitis Ten Years after LASIK

Diffuse Lamellar Keratitis Ten Years after LASIK. Elena Basli, Barbara Ameline, Jean-Christophe Gavrilov, Laurent Laroche, Vincent Borderie Quinze-Vingts National Hospital, Paris, France All co-authors would like to disclosure the lack of any financial interest. Purpose.

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Diffuse Lamellar Keratitis Ten Years after LASIK

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  1. Diffuse Lamellar Keratitis Ten Years after LASIK Elena Basli, Barbara Ameline, Jean-Christophe Gavrilov, Laurent Laroche, Vincent Borderie Quinze-Vingts National Hospital, Paris, France All co-authors would like to disclosure the lack of any financial interest.

  2. Purpose • To reporta case of Diffuse Lamellar Keratitis (DLK) secondary to bacterial corneal ulcer, 10 years after LASIK

  3. Materials • 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 right eye

  4. Clinical examination at the emergencies • 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)

  5. Treatment • 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

  6. Evolution • 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 eye drops • Day 15 : VA: 10/10 with -4.50(-2.25)135°, interface was cleared • Results of corneal tissue retrieval were negative but those of the lens were positive for pyocyanic.

  7. Conclusions • 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 aremandatory • 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)

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