Recurrent Late Diffuse Lamellar Keratopathy Induced By Corneal Dellen Following Significant Lasik-Epithelial Ingrowth

To report a case of recurrent late diffuse lamellar keratopathy (DLK) following epithelial ingrowth beneath the lamellar in-situ keratomileusis (LASIK) flap.

Hadassah Medical Center - Hebrew University Hospital.

A 70-year-old man with a history of bilateral myopic LASIK surgery and enhancement 20 years prior presented with left eye decreased visual acuity, pain, redness, and tearing. On examination of the left eye, whitish clumps (epithelial ingrowths) were evident in the corneal interface beneath a thick LASIK flap in the inferior cornea, and DLK was observed. The flap was irregular, with an irregular cornea surrounding the flap and with an epithelial defect (Dellen) evident clinically and in anterior segment optical coherence tomography (AS-OCT). Lab cultures from the eroded area returned negative. The patient was treated with resolving epithelial defect and DLK. However, the patient returned twice with the same clinical picture and erosion at the same site. His condition was diagnosed as recurrent DLK triggered by the corneal Dellen secondary to the irregular cornea post-epithelial ingrowth melt. Finally, his recurrences were treated successfully with topical lubrication and steroids.

Epithelial ingrowth is an important complication following LASIK surgery. This case demonstrates cardinal mechanisms resulting from epithelial ingrowth, including corneal melt with irregular flap borders, secondary Dellen areas, resultant recurrent epithelial defect, and, consequently DLK. We hope this case will provoke further clinical awareness of these findings in post-LASIK patients.