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Focal sterile lamellar keratitis after SMILE uncharacteristic of classical DLK

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Session Details

Session Title: SMILE, LASIK and Re-treatment

Session Date/Time: Monday 09/10/2017 | 14:30-16:00

Paper Time: 14:54

Venue: Room 2.1

First Author: : A.Stuart UK

Co Author(s): :    D. Reinstein   G. Carp   T. Archer              

Abstract Details


To describe the presentation of diffuse lamellar keratitis (DLK) after SMILE, as well as report the incidence, management, and outcomes.


London Vision Clinic London


This was a retrospective review of the population of 4,000 consecutive eyes treated by SMILE at London Vision Clinic using the VisuMax femtosecond laser (Carl Zeiss Meditec). Inclusion criteria were for the patient to have undergone SMILE and have presented in the early follow-up period with DLK grade 1 or higher. The incidence was measured and categorized according to being primary or secondary and by presenting appearance. Patients were followed for 1 year after surgery and standard outcomes analysis was performed.


There were 18 cases (0.45%) of DLK grade 1 or higher. Of these, 12 cases (67%) were of classical appearance and 6 cases (33%) presented as multifocal inflammatory keratitis, uncharacteristic of classical DLK in LASIK The DLK was primary in 11 cases (61%) and secondary in 7 cases (39%), causes included minor epithelial defect (n=4), large epithelial slide during surgery (n=1), idiopathic immune sterile keratitis (n=1), and auto-immune keratitis (n=1). An interface washout was required for 4 eyes (22%). Postoperative UDVA was 20/20 or better in 80% of eyes.


A different type of DLK presentation can occur after SMILE, characterized by multiple focal sterile inflammatory spots. Management is the same as for classical DLK and the outcome is not affected if treated upon presentation.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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