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Vera-Duarte GR, Guerrero-Becerril J, Müller-Morales CA, Ramirez-Miranda A, Navas A, Graue-Hernandez EO. Delayed-onset pressure-induced interlamellar stromal keratitis (PISK) and interface epithelial ingrowth 10 years after laser-assisted in situ keratomileusis. Am J Ophthalmol Case Rep 2023; 32:101874. [PMID: 38161519 PMCID: PMC10757168 DOI: 10.1016/j.ajoc.2023.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To report a case of pressure-induced interlamellar stromal keratitis (PISK) 10 years after laser assisted in situ keratomileusis (LASIK). Observations A case of a 36-year-old man who underwent LASIK and presented with PISK 10 years later. Before presenting to our department he consulted elsewhere for red eye, decreased visual acuity, foreign body sensation, and pain on the RE for 1 week. He was then prescribed topical prednisolone six times per day and was lost to follow-up. On examination and after 1 month of continuous use of steroids uncorrected distance visual acuity (UCDV) was 20/400 in the right eye (RE) and 20/20 in the left eye (LE). Best corrected visual acuity was 20/80 on the RE. The Goldmann intraocular pressure (IOP) was 26 and 17 mmHg in the RE and LE, respectively. Slit lamp biomicroscopy revealed fluid in the interface and epithelial ingrowth. Fundoscopic examination results were normal in both eyes. Treatment was initiated with topical brimonidine tartrate 0.2%, timolol 0.5%, and dorzolamide 2.0% BID. Once the pressure was controlled the patient was scheduled for mechanical debridement of the epithelial ingrowth with significant improvement of UCVA (20/25). Conclusions Refractive surgeons should be aware of PISK as a potential complication of LASIK even years after the procedure. Intraocular pressure can be misleading, and diligent and careful examination are key to diagnosis and treatment of this potentially blinding complication.
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Affiliation(s)
- Guillermo Raul Vera-Duarte
- Instituto de Oftalmología Fundación Conde de Valenciana FAP, Department of Cornea, external disease and Refractive Surgery, Chimalpopoca 14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Jesus Guerrero-Becerril
- Instituto de Oftalmología Fundación Conde de Valenciana FAP, Department of Cornea, external disease and Refractive Surgery, Chimalpopoca 14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Carlos Adolfo Müller-Morales
- Instituto de Oftalmología Fundación Conde de Valenciana FAP, Department of Cornea, external disease and Refractive Surgery, Chimalpopoca 14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Instituto de Oftalmología Fundación Conde de Valenciana FAP, Department of Cornea, external disease and Refractive Surgery, Chimalpopoca 14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Alejandro Navas
- Instituto de Oftalmología Fundación Conde de Valenciana FAP, Department of Cornea, external disease and Refractive Surgery, Chimalpopoca 14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Enrique O. Graue-Hernandez
- Instituto de Oftalmología Fundación Conde de Valenciana FAP, Department of Cornea, external disease and Refractive Surgery, Chimalpopoca 14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
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Lin HY, Ho WT. Diffuse lamellar keratitis as a rare complication of diamond burr superficial keratectomy for recurrent corneal erosion: a case report. BMC Ophthalmol 2022; 22:362. [PMID: 36071403 PMCID: PMC9450270 DOI: 10.1186/s12886-022-02589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background To present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE). Case presentation A 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20. Conclusions Diffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions.
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Affiliation(s)
- Hung-Yu Lin
- Department of Ophthalmology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Wei-Ting Ho
- Department of Ophthalmology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
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Dan TT, Liu TX, Liao YL, Li ZZ. Delayed diffuse lamellar keratitis after small-incision lenticule extraction related to immunoglobulin A nephropathy: A case report. World J Clin Cases 2022; 10:4131-4136. [PMID: 35665110 PMCID: PMC9131215 DOI: 10.12998/wjcc.v10.i13.4131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/09/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffuse lamellar keratitis (DLK) is a complication of laser-assisted in situ keratomileusis (LASIK). This condition can also develop after small-incision lenticule extraction (SMILE) with a distinctive appearance. We report the case involving a female patient with delayed onset DLK accompanied by immunoglobulin A (IgA) nephropathy.
CASE SUMMARY A 22-year-old woman was referred to our department for DLK and a decline in vision 1 mo after undergoing SMILE. The initial examination showed grade 2 DLK in the flap involving the central visual axis of the right eye. She was immediately administered with a large dose of a topical steroid for 30 d. However, the treatment was ineffective. Her vision deteriorated from 10/20 to 6/20, and DLK gradually worsened from grade 2 to 4. Eventually, interface washout was performed, after which her vision improved. DLK completely disappeared 2 mo after washout. Six months after SMILE, the patient was diagnosed with IgA nephropathy due to a 4-year history of interstitial hematuria.
CONCLUSION DLK is a typical complication of LASIK but can also develop after SMILE. Topical steroid therapy was ineffective in our patient, and interface washout was required. IgA nephropathy could be one of the factors contributing to the development of delayed DLK after SMILE.
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Affiliation(s)
- Ting-Ting Dan
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Tai-Xiang Liu
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Yi-Lu Liao
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Zong-Ze Li
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Sahay P, Bafna RK, Reddy JC, Vajpayee RB, Sharma N. Complications of laser-assisted in situ keratomileusis. Indian J Ophthalmol 2021; 69:1658-1669. [PMID: 34146007 PMCID: PMC8374806 DOI: 10.4103/ijo.ijo_1872_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/19/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is one of the most commonly performed kerato-refractive surgery globally. Since its introduction in 1990, there has been a constant evolution in its technology to improve the visual outcome. The safety, efficacy, and predictability of LASIK are well known, but complications with this procedure, although rare, are not unknown. Literature review suggests that intraoperative complications include suction loss, free cap, flap tear, buttonhole flap, decentered ablation, central island, interface debris, femtosecond laser-related complications, and others. The postoperative complications include flap striae, flap dislocation, residual refractive error, diffuse lamellar keratitis, microbial keratitis, epithelial ingrowth, refractive regression, corneal ectasia, and others. This review aims to provide a comprehensive knowledge of risk factors, clinical features, and management protocol of all the reported complications of LASIK. This knowledge will help in prevention as well as early identification and timely intervention with the appropriate strategy for achieving optimal visual outcome even in the face of complications.
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Affiliation(s)
- Pranita Sahay
- Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India
| | - Rahul Kumar Bafna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jagadesh C Reddy
- Cataract and Refractive Surgery Services, Cornea Institute, L V Prasad Eye Institute, L V Prasad Marg, Roan No-2, Banjara Hills, Hyderabad, Telangana, India
| | - Rasik B Vajpayee
- Vision Eye Institute, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Alqahtani SS. A Case Report of Diffuse Lamellar Keratitis after FemtoSMILE Refractive Surgery. Case Rep Ophthalmol 2020; 11:582-587. [PMID: 33437231 PMCID: PMC7747090 DOI: 10.1159/000509851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/03/2022] Open
Abstract
Diffuse lamellar keratitis (DLK) is not an uncommon complication of the small-incision lenticule extraction (SMILE) operation. Instrumental causes, such as contamination, are usually the underlying etiological route. Herein, we present an atypical case of DLK with numerous foci of cellular infiltrates on day 1. No evidence of any diffuse inflammatory response was reported. On the other hand, the multifocal response began to improve starting on the third day, after the administration of systemic steroids, with pain and discomfort significantly disappearing on the second day. Antibiotics were given as well, in the case of secondary infections. After 1 week of treatment and close monitoring, significant improvement was reported, and the slit-lamp examination was unremarkable.
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Affiliation(s)
- Saeed S Alqahtani
- Department of Surgery, Faculty of Medicine, Najran University, Najran, Saudi Arabia
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Balestrazzi A, Balestrazzi A, Giannico MI, Michieletto P, Balestrazzi E. Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report. Case Rep Ophthalmol 2018; 9:457-464. [PMID: 30519182 PMCID: PMC6276763 DOI: 10.1159/000493338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022] Open
Abstract
We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS® IntraLase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. High-dose dexamethasone eyedrops with topical antibiotic and artificial tears were prescribed. Five days after surgery, a central corneal opacity with convergent striae was detected at biomicroscopy. The suspicion of DLK was confirmed. Additional therapy based on hyperosmolar ophthalmological solution, oral doxycycline, and topical 10% sodium citrate was prescribed. Treatment was continued and tapered for over 3 months. Improvement in corneal transparency were obtained 2 weeks after the systemic therapy had been started. Uncorrected visual acuity improved from 20/32 to 20/20 at 1-year follow-up. DLK represents an infrequent complication after femto-LASIK. It should resolve without sequelae if promptly diagnosed and treated, without necessity of corneal flap lifting.
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Moshirfar M, Masud M, Shah TJ, Avila MR, Hoopes PC. Chemical conjunctivitis and diffuse lamellar keratitis after removal of eyelash extensions. Am J Ophthalmol Case Rep 2018; 12:21-23. [PMID: 30128373 PMCID: PMC6098230 DOI: 10.1016/j.ajoc.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/04/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose There have been several reports in the literature demonstrating the adverse effects of multiple ocular cosmetic procedures, such as eyelash extensions, eyeliner tattoo, and eyelash dyeing. To our knowledge, there is limited literature on the adverse effects specifically attributed to the chemicals and process of eyelash extension removal. Our purpose is to demonstrate the possible ocular injuries from misapplication of eyelash extension removal solvent. Observations We present a unique case of a 46-year-old female with a prior history of laser assisted in-situ keratomileusis (LASIK) who presented with bilateral chemical conjunctivitis and diffuse lamellar keratitis (DLK) secondary to epithelial defects following the misapplication of eyelash extension removal gel. Conclusionand importance Given that our patient suffered significant dry eyes, corneal haze, and visual fluctuation, we believe this case underscores the importance of continuing closer and careful evaluation into the chemicals present in these cosmetics to improve the safety of our patients and to limit such incidents from occurring hereafter.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.,Utah Lions Eye Bank, Murray, UT, USA.,HDR Research Center, Hoopes Vision, Draper, UT, USA
| | | | - Tirth J Shah
- Department of Ophthamology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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