Delayed-onset diffuse lamellar keratitis due to retained SMILE lenticule: A case report and literature review.

RATIONALE

Delayed-onset diffuse lamellar keratitis is a rare but serious complication that can occur after small incision lenticule extraction surgery. Retained lenticules may act as foreign bodies, potentially triggering inflammatory reactions in the cornea.

PATIENT CONCERNS

A 30-year-old Chinese woman was referred for ophthalmological assessment due to declining vision in both eyes for more than 10 years. She had been wearing glasses for 4 years and contact lenses for 2 years.

DIAGNOSES

The patient was diagnosed with myopia.

INTERVENTIONS

The patient underwent uneventful small incision lenticule extraction surgery in the right eye but did not get lenticule extracted in the left eye. Then she developed symptoms of keratitis in the left eye on postoperative day 5, characterized by diffuse gray-white stromal opacities. Immediate treatment with anti-inflammatory medications and irrigation effectively controlled the inflammation. Subsequently, a second lenticule extraction procedure was performed.

OUTCOMES

Corneal transparency and visual clarity restored in the left eye. The visual acuity of both eyes improved to 1.2 at 3 months after surgery.

LESSONS

This case report emphasizes the link between delayed-onset diffuse lamellar keratitis and retained lenticules, which may act as foreign bodies triggering inflammatory reactions in the cornea. Clinicians should diagnose and treat this keratitis promptly to support successful visual recovery and patient satisfaction. Further research should explore the pathogenesis and risk factors to improve management strategies.