Late‐Onset Diffuse Lamellar Keratitis associated with cataract phacoemulsification

AbstractPurpose Diffuse lamellar keratitis (DLK) is characterized by the presence of a diffuse inflammatory infiltrate localized at the laser in situ keratomileusis interface, with a non‐infectious etiology. Most cases of DLK occur within the first week following surgery but late‐onset DLK has been associated with inflammatory conditions such as iritis, viral keratoconjunctivitis or interstitial keratitis; and it can occur even years after LASIK.Methods Prospective, interventional, single case report. A 67‐year‐old male patient, who had undergone bilateral LASIK 13 years earlier, developed an episode of DLK on the third day of the postoperative‐cataract surgery on his left eye (LE). Slit‐lamp biomicroscopy and optical coherence tomography (anterior segment mode) were performed to demonstrate the presence of highly‐reflective multifocal infiltrates and the absence of fluid at the flap interface. The patient was treated with intensive topical corticosteroids.Results Treatment with topical 1.0% prednisolone acetate was instituted and continued for months, with improvement in patient symptoms and visual acuity.Conclusion This is a case of DLK with an extremely delayed onset, which emphasizes the importance of following‐up of these patients not only in the early postoperative period.