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Late Diffuse Lamellar Keratitis in Post-LASIK Infective Keratitis

Late Diffuse Lamellar Keratitis in Post-LASIK Infective Keratitis. Dr. Umang Mathur Dr. Amit Agrawal Dr. Manisha Acharya The authors have no financial interest in the subject of this poster. History.

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Late Diffuse Lamellar Keratitis in Post-LASIK Infective Keratitis

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  1. Late Diffuse Lamellar Keratitis in Post-LASIK Infective Keratitis Dr. Umang Mathur Dr. Amit Agrawal Dr. Manisha Acharya The authors have no financial interest in the subject of this poster

  2. History • 23-year-old female underwent uneventful Bilateral Myopic LASIK, elsewhere, on 22nd January 2008 • Post-operative # 3 Patient presents to the doctor with Bilateral Infective Keratitis • Pain, Photophobia, Redness, Watering/Discharge • Vision: CF 1/2m, both eyes • Central infiltrates, both eyes New Delhi, India

  3. Management Flap lifted in both eyes and scraping sent for Bacterial and Fungal smears and culture No organisms grown Empirical treatment • Moxifloxacin eye drops q1h • Tobramycin eye drops q1h • Natamycin eye drops q1h • Cyclopentolate eye drops tid New Delhi, India

  4. Post-operative # 7 Patient responds to treatment • ↓ Pain, watering, photophobia • ↓ size of infiltration • Improvement in Vision, RE>LE Impression: Healing Keratitis New Delhi, India

  5. Post-operative # 13 • ↑ ↑ Pain, watering, photophobia • ↑ Congestion • ↑ signs of inflammation Referred to us for opinion and management New Delhi, India

  6. Post-operative # 13 OS OD New Delhi, India BCVA: CF 50cm BCVA: CF 50cm

  7. What are we dealing with? • Unresolved infection? • Why recurrence after good initial response? • Atypical infection • Immunocompromised patient…HIV? • Blood reports WNL • Collagen vascular disease? • RA factor, ANA, CRP, ESR: WNL • Clinically: WNL • Blepharokeratoconjunctivitis? • Clinically: WNL • HSV Keratitis? • No history of recurrence • ?Bilateral and simultaneous- very rare New Delhi, India

  8. Review OS OD DLK? Stromal Edema Prednisolone acetate eye drops tid, added New Delhi, India

  9. Post-operative # 20 • Symptomatic relief • ↓ Congestion, Infiltrate, Stromal edema • Topical steroids frequency increased New Delhi, India

  10. OD: 20/20p (-1D cyl x 20) OS: 20/100 ( 20/20p with RGP Contacts) Post-operative # 30 New Delhi, India

  11. B/L DLK, Post-LASIK Infective Keratitis OD OS New Delhi, India

  12. Discussion • Diffuse lamellar keratitis (DLK) is an inflammatory infiltrate occurring at the keratectomy interface after laser in situ keratomileusis (LASIK) • Endotoxins released from bacteria and inflammatory bi-products may be the causative agents for producing DLK in our case • While the infection was controlled by the Antibiotic treatment, endotoxins released from the bacteria continued to produce an inflammatory reaction Holland SP, Mathias RG, et.al. Diffuse lamellar keratitis related to endotoxins released from sterlizer reservoir biofilms. Ophthalmology. 2000 Jul;107(7):1227-33 Peters NT, Iskander NG,et.al. Diffuse lamellar keratitis: isolation of endotoxin and demonstartion of the inflammatory potential in a rabbit laser in situ keratomileusis model. J Cataract Refract Surg. 2001 Jun;27(6):917-23 New Delhi, India

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