K 740Diffuse lamellar keratitis (DLK) following laser in situ keratomileusis (LASIK): Clinical and confocal microscopic findings
J. Bühren, M. Baumeister, G. W. K. Steinkamp, T. Kohnen
Background: Diffuse lamellar keratitis (DLK) is a sterile inflammation of the flap interface occurring in the first days following LASIK. We demonstrate clinical and confocal microscopic findings of four different cases of DLK.
Methods: Four patients with DLK following LASIK, LASIK re-treatment, and flap re-lifting after LASIK were examined by slit-lamp and confocal microscopy (Confoscan P4, Tomey) in the first postoperative week.
Results: Slit-lamp examination at 1-3 days postoperatively showed a streaky-granular infiltrate at the interface level in all of our cases. The anterior chamber showed no sign of inflammation. Confocal microscopy revealed mononuclear cells and granulocytes at the interface level. The other corneal layers showed no changes. Under therapy with topical steroids the infiltrate disappeared. Seven days after LASIK we found in two cases remnants of the infiltrate at the central cornea. The confocal microscope showed no active inflammation at this time: the mononuclear cells had disappeared and the granulocytes had clumped to a highly reflective amorphous substance.
Discussion: Our findings confirmed the clinical observation that DLK is a inflammation confined to the flap interface and can be sufficiently treated with topical steroids. Despite different clinical history (microkeratome use vs. flap re-lifting) and intensity, all cases showed a similar clinical course: 7 days after LASIK only remnants of the initial cellular infiltrate could be found.
Universitätsaugenklinik Frankfurt/Main, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main