Cornea Cases

Title:

Atypical diffuse lamellar keratitis: a case report

Case Report Details

First Author: C.Bouza-Miguens SPAIN

Co Author(s):    M. Calvo   M. Djodeyre   F. Calle   F. Llovet   J. Ortega-Usobiaga        

Abstract Details

Purpose:

To report the atypical occurrence of diffuse lamellar keratitis (DLK) along with central toxic keratopathy (CTK) after a primary LASIK surgery.

Setting:

Baviera Clinic, Madrid, Spain.

Report of case or case series:

A 42-year-old Caucasian female underwent uneventful bilateral LASIK surgery using the One-Use-Plus SBK microkeratome (Moria, Antony, France). Postoperative treatment consisted of topical instillation every 6 hours for a week of moxifloxacin and the combination of tobramycin/dexamethasone. Intraocular pressure remained stable during all the postoperative follow-up. Five days after surgery, the biomicroscopy showed the appearance of grade 3 DLK, in coexistence with temporary CTK, generating a significant scar and compromising the visual axis of the patient. A hyperopic defect, irregular astigmatism and an important corrected distance visual acuity (CDVA) loss was also observed. Corticosteroid treatment was immediately increased, adjusting the dose according to the evolution. Surprisingly the patient responded to topical corticosteroids and no flap lifting was required, as it is necessary in DLK grade 3.

Conclusions/Take Home Message:

In such advanced cases of DLK, flap lifting, interface cleaning and scraping seems to be only necessary to prevent flap necrosis and inflammation worsening, if there is no good initial response to the use of corticosteroids. It should be also noted that sometimes the benefit of flap lifting could be limited, as loss of tissue could occur due to corneal friability secondary to the action of collagenases.