Incidence And Clinical Outcomes Following Management In Eyes Presenting With Diffuse Lamellar Keratitis (Dlk) Post Smile.

To report the incidence, management strategies and clinical outcomes following resolution in cases of DLK post SMILE from a high- volume refractive surgery center in India.

Nethradhama Superspeciality eye hospital, Bangalore, India 

This retrospectively study reviewed patients operated for SMILE for varying degrees of myopia from Dec 2021 to Dec2022, presenting with signs of diffuse lamellar keratitis or interface inflammation like clinical picture. The pre-operative clinical characteristics, intraoperative parameters, postoperative treatment, overall incidence, severity, clinical outcomes after resolution were recorded. Uncorrected distance visual acuity (UDVA), Corrected distance visual acuity (CDVA) and Objective scatter index (OSI) by HD analyzer (HDA) were monitored from the presentation until the resolution. 

A total of 1313 eyes were analyzed,of which 18 developed DLK with recorded incidence being 1.37 %.Of the 18, 11 eyes of grade 1 DLK were managed by stepping up topical steroid,remaining 7 eyes of grade-2 DLK were intervened by interface wash.The mean LogMAR UDVA & CDVA at presentation was 0.18±0.16 & 0.16±0.17 respectively,improved to 0.01±0.14 & -0.03±0.10 by end of resolution(p< 0.05).The DLK cases presented at mean of 2.7 days,with resolution seen within 8.9 days.A mean OSI of 2.96±1.95 at presentation improved to 1.28±0.75 upon resolution(p< 0.05).The mean energy offset of 26.33±1.71 nJ intraoperatively showed a positive 

Diffuse lamellar keratitis post SMILE, when recognised  and managed early using an appropriate approach, results in satisfactory outcomes, without any permanent effects on visual acuity. The occurrence of this entity may be related to the intra-operative laser energy offset used.