Diffuse lamellar keratitis associated with recurrent corneal erosions after laser in situ keratomileusis

PURPOSE: Diffuse lamellar keratitis (DLK) is marked by the presence of diff use 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 w eek 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 w as rapid development of DLK. Slit-lamp biomicroscopy and in vivo scanning s lit confocal microscopy were performed. The patient was treated with intens ive topical corticosteroids. RESULTS: Scanning slit confocal microscopy revealed numerous, highly-reflec tive round bodies consistent with a polymorphonuclear infiltrate located at the flap interface. Treatment with topical 1.0% prednisolone acetate was i nstituted, with rapid improvement in patient symptoms, visual acuity, and s lit-lamp biomicroscopy. CONCLUSIONS: Diffuse lamellar keratitis may occur months after LASIK as a r esult of a spontaneous recurrent corneal epithelial erosion.