1. Diffuse Lamellar Keratitis Ten Years after LASIK
Elena Basli, Barbara Ameline, Jean-Christophe Gavrilov, Laurent Laroche, Vincent Borderie
Quinze-Vingts National Hospital, Paris, France
All co-authors would like to disclosure the lack of any financial interest.

2. Purpose
To report a case of Diffuse Lamellar Keratitis (DLK) secondary to bacterial corneal ulcer, 10 years after LASIK

3. Materials
A 35 years old man with a myopia of - 8 dioptries on both eyes, underwent uneventful lasik in 1996 on his right eye and PKR on his left eye.
Undercorrection led him to wear soft contact lenses after one year.
Ten years later he was referred to us complaining of pain, blurred vision, foreign body sensation, and light sensitivity in his right eye

4. Clinical examination at the emergencies
Corrected VA on his right eye : 12 / 60.
Slit lamp examination : ulceration of the cornea with peripheral infiltrates, punctuate epithelial keratitis, folds of the Descemet membrane, secondary anterior uveitis with Tyndall (+2) and :
Infiltrates of the interface aggregating in the central visual axis. (Sands of the Sahara syndrome, Stage 3)

6. Treatment
Initial instillation of topical fortified antibiotics at hourly intervals were applied (Ticarcillin, Gentamycin and Vancomycin) for the first 3 days, cycloplegics (atropine 1%) and artificial eye drops
Corneal tissue retrieval, microbiological analysis of the contact lens, HRT and OCT Visante were performed

9. Evolution
Day 3 : the response to antobiotic therapy was favourable on the ulcer. Interface didn’t improve. We therefore initiated topical steroids (conjunctival injections) on day 3 and reduced the frequency of antibiotics instillation at 6 times daily.
Day 7 : improvement was confirmed, fortified drops were substituted for weaker commercial preparation of Tobramycin, Dexamethasone, Cefuroxim and artificial eye drops
Day 15 : VA: 10/10 with -4.50(-2.25)135°, interface was cleared
Results of corneal tissue retrieval were negative but those of the lens were positive for pyocyanic.

11. Conclusions
DLK can occur not only months but even years, after surgery in case on an epithelial trauma, loss of epithelial integrity with or without bacterial inflammation or disruption of the flap.
Quick diagnosis and treatment are mandatory
Antibacterial treatment associated with aggressive steroid therapy allow complete recovery
Response to treatment was in this case comparable to an early Diffuse Lamellar Keratitis (DLK)