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R. Scotto, M. Papadia, A. Bagnis, C. E. Traverso; Follow-Up With Laser Confocal Microscopic and Anterior Segment OCT of Patients With Diffuse Lamellar Keratitis , Also Known as "Sand of Sahara Syndrome", After LASIK. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5677.
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To evaluate the corneal characteristics of patients who underwent LASIK and presented with diffuse lamellar keratitis (DLK) after 4 days using in vivo laser confocal microscopy and anterior segment OCT.
5 eyes of 4 patients who underwent LASIK (4 eyes for myopic and 1 eye for hyperopic correction) presented 4 days after the treatment with diffuse lamellar keratitis despite topical treatment with steroids and no obvious systemic disease. The patients underwent slit-lamp examination, visual acuity evaluation, confocal microscopy and anterior segment OCT assessment at baseline and at every follow-up visit.
The visual acuity at the first visit was 20/40 in 3 eyes, 20/60 in 1 eye and 20/80 in 1 eye. Slit-lamp examination revealed diffuse, multifocal and granular haze in the stroma underneath the flap. Anterior segment OCT revealed a hyperreflective line 150 µm beneath the epithelium corresponding top the flap and a diffuse hyperreflective tissue above and under the stroma. Confocal microscopy demonstrated multiple dendritic cells in the basal layer (mean density 12±4.2 cell/mm2), high reflectivity of the extracellular matrix and a reduction of keratocytes in the anterior stroma. The subepithelial nerve plexus was not visualized, the posterior stroma and the endothelial layer was within normal limits. After intense treatment with topical steroids DLK resolved and corneal transparency was achieved with complete restoration of visual acuity. At the last visit visual acuity was 20/20 in all eyes, anterior segment OCT revealed a hypereflective line, corresponding to the flap while the stroma had homogeneous reflection. Confocal microscopy demonstrated a reduction of dendritic cells and a reduction of the reflectivity of the extra-cellular matrix of the residual stroma.
DLK is a rare complication that may occur in patients who underwent LASIK. Anterior segment OCT and confocal microscopy might be important tools in the diagnosis and follow up of this disease.
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