Diffuse lamellar keratitis (DLK)

June 5, 2023/

Diffuse lamellar keratitis (DLK) is a rare, but potentially serious complication of LASIK surgery. DLK can occur at any time after LASIK surgery, and can cause significant vision loss if left untreated.

Here are some important points to keep in mind about DLK:

DLK:

  • Is characterized by the presence of diffuse, white, infiltrative opacities in the corneal flap interface.
  • Can occur at any time after LASIK surgery, but is most commonly seen in the first 1-4 weeks after surgery.
  • Is typically asymptomatic, but can cause pain, redness, and tearing in more severe cases.
  • Is diagnosed based on clinical examination findings, including the presence of diffuse corneal opacities and/or interface haze.
  • Is typically managed with aggressive topical corticosteroids, as well as close monitoring for signs of progression or complications such as infection or flap dislocation.
  • Threshold DLK is a more severe form of DLK that is associated with greater inflammation and more extensive corneal involvement.
  • Threshold DLK typically requires more aggressive treatment, including high-dose topical corticosteroids and possible surgical intervention such as flap lifting or irrigation of the interface.

Differential diagnosis to DLK:

  • Interface fluid syndrome is a condition that can mimic DLK, but is characterized by the presence of fluid accumulation in the corneal interface rather than inflammatory opacities.
  • Central toxic keratopathy is another condition that can mimic DLK, but is characterized by the presence of a central corneal opacity rather than diffuse opacities in the interface.

In conclusion, DLK is a rare but potentially serious complication of LASIK surgery. Ophthalmologists should be familiar with the characteristic findings of DLK on clinical examination, as well as the differential diagnosis to DLK. Early diagnosis and appropriate management can help prevent complications and improve outcomes for patients who develop this condition.