Harrison D A, Periman L M
Department of Ophthalmology, University of Washington, Seattle 98195-6485, USA.
J Refract Surg. 2001 Jul-Aug;17(4):463-5. doi: 10.3928/1081-597X-20010701-09.
Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis (LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or two following surgery.
We describe one case of diffuse lamellar keratitis that occurred 3 months after LASIK. The patient developed a spontaneous corneal erosion in one eye. Over the next 2 days while the erosion was being treated, there was rapid development of DLK. Slit-lamp biomicroscopy and in vivo scanning slit confocal microscopy were performed. The patient was treated with intensive topical corticosteroids.
Scanning slit confocal microscopy revealed numerous, highly-reflective round bodies consistent with a polymorphonuclear infiltrate located at the flap interface. Treatment with topical 1.0% prednisolone acetate was instituted, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopy.
Diffuse lamellar keratitis may occur months after LASIK as a result of a spontaneous recurrent corneal epithelial erosion.
弥漫性板层角膜炎（DLK）的特征是在准分子原位角膜磨镶术（LASIK）界面出现弥漫性或多灶性浸润。这些浸润培养阴性，病因被认为是非感染性的。大多数DLK病例发生在术后第一周或两周内。
我们描述了1例LASIK术后3个月发生弥漫性板层角膜炎的病例。该患者一只眼睛出现自发性角膜上皮糜烂。在接下来治疗角膜上皮糜烂的2天里，DLK迅速发展。进行了裂隙灯生物显微镜检查和活体扫描裂隙共焦显微镜检查。患者接受了强化局部皮质类固醇治疗。
扫描裂隙共焦显微镜检查显示，在角膜瓣界面有大量高反射圆形物体，符合多形核白细胞浸润。给予局部1.0%醋酸泼尼松龙治疗后，患者症状、视力及裂隙灯生物显微镜检查结果迅速改善。
弥漫性板层角膜炎可能在LASIK术后数月因自发性复发性角膜上皮糜烂而发生。
