Late-Onset Diffuse Lamellar Keratitis 20 Years After Laser In Situ Keratomileusis

To report the case of late-onset diffuse lamellar keratitis (DLK) in the right eye of a 43-year-old male, 20 years after uneventful bilateral LASIK.

Single case report of DLK in a 43-year-old male in Hospital Clínic Barcelona, Spain.

A 43-year-old patient, with a history of myopic LASIK at age 23, presented to our clinic with corneal erosion in his right eye, resulting from a finger injury that occurred 72 hours ago. He was receiving topical antibiotics three times a day. The patient complained of a sensation of a foreign body, redness, and severe blurred vision developed after the initial diagnosis.

Visual acuity was 20/200 in the right eye and 20/20 in the left eye. Examination revealed inferior corneal erosion with a well-positioned flap and diffuse, white, granular infiltrate extending to the pupillary axis, leading to a diagnosis of stage 2 DLK. Anterior segment optical coherence tomography (AS-OCT) showed interface hyperrefringence.

The treatment included a therapeutic contact lens, topical corticosteroid every hour, and topical antibiotic for prophylaxis. Daily follow-up was conducted until complete re-epithelialization was achieved, ensuring no impact on the visual axis by DLK. By day 6, the patient achieved 20/20 visual acuity without correction, with nearly complete normalization of anterior corneal elevation on topography and a normal interface in the AS-OCT.

Strict monitoring is essential for patients with corneal erosion and a history of LASIK due to the risk of developing DLK. Consider preventive topical corticosteroid therapy in the context of corneal erosion in patients with prior LASIK surgery.