Confocal microscopic characteristics of stage 1 to 4 diffuse lamellar keratitis after laser in situ keratomileusis.

PURPOSE

To evaluate 4 stages of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis using confocal microscopy.

SETTING

Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.

METHODS

This retrospective study comprised 17 eyes (15 patients): 11 cases of stage 1 DLK, 5 cases of stage 2, 1 case of stage 3, and 2 cases of stage 4. All eyes were examined by slitlamp biomicroscopy and confocal microscopy.

RESULTS

In all cases of stage 1 and 2 DLK, confocal microscopy showed infiltration of inflammatory cells into the flap stroma and the interface. The density of the infiltrates and the number of cells varied within the stage 1 corneas; all stage 2 corneas had dense infiltrates. In the eye with stage 3 DLK, an aggregation of presumed cell remnants was noticed. In the stage 4 cases, there was no active inflammation but stromal folds and numerous activated keratocytes were detected.

CONCLUSIONS

Confocal microscopy showed differences in the appearances of the DLK groups. There were similarities in the features of stages 1 and 2. Only stages 1 and 2 represented active inflammation, whereas stages 3 and 4 showed the result of accumulation and decay of the inflammatory cells.