Diffuse Lamellar Keratitis DLK

Diffuse Lamellar Keratitis with mild central corneal Haziness. It is one of the lasik eye surgery complication© 2013 American Academy of Ophthalmology
Diffuse lamellar keratitis in the left image. Haziness in the central cornea. Right image shows same eye with clear cornea after phototherapeutic keratectomy.

Diffuse Lamellar Keratitis

It is corneal inflammation that arises between the corneal flap and the corneal bed after lasik surgery in the early post operative period.It can range from mild with no or little symptoms in which it will regress spontaneously, to severe inflammation with corneal haziness,eye pain and blurred vision in which it needs aggressive treatments with topical steroid and antibiotics with flap lifting and irrigation of the interface with steroid and antibiotics.

DLK can also be called Sands of Sahara because it appears like waves of sands under the slit-lamp examination.

The causes of DLK are inflammatory cells, bacterial toxins, eyelid secretions and other debris that get access to the area between the flap and corneal stromal bed causing inflammation.

Without treatment, this complication can cause corneal scar. Sometimes despite these treatments, it leaves small corneal opacities that can affect your vision.

To prevent this complication from occurring, patient should be treated from blepharitis before Lasik Eye Surgery and during lasik surgery,the eye lashes should be directed away from the cornea. There should be good and sterile irrigation of the cornea before the flap is created and also after flap is created to remove any debris and dead cells.

It is important to prevent debris accumulation under the flap or on the corneal bed and also it is very important to irrigate the corneal bed after laser ablation. This irrigation will washout dead cells and debris.

Sometimes when severe lamellar keratitis did not respond to steroid eye drops, the surgeon may lift the corneal flap and irrigate underneath it with sterile fluid, steroid and antibiotics to remove any inflammatory cells and debris.

Another way of treatment is to use phototherapeutic keratectomy or PTK. PTK  laser eye procedure that uses 193 nm excimer laser to treat anterior corneal defects or irregularities.In DLK, PTK can be used on stromal bed to remove any debris and remanent inflammatory cells.

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