Confocal microscopic findings in a case of delayed-onset bilateral diffuse lamellar keratitis after laser in situ keratomileusis

We report a case of bilateral diffuse lamellar keratitis (DLK) with delayed onset after a bilateral laser in situ keratomileusis (LASIK) procedure. A thorough history, review of systems, and laboratory evaluation revealed no pertinent medical history or risk factors for delayed-onset DLK after LASIK. Confocal microscopic examination of both corneas demonstrated a large number of activated keratocytes in the flap interface, particulate debris of variable size distributed throughout the interface, and scattered inflammatory cells. It was then decided to lift and wash both corneal flaps and interfaces. Scrapings for stains and cultures were also taken from both flap beds and were negative. After treatment with prednisolone acetate 1% and topical cyclosporin A 0.5%, the DLK resolved in both eyes with residual faint, diffuse, corneal haze. The patient developed a steroid-induced elevation in intraocular pressure that resolved after the topical corticosteroids were stopped.