Diffuse Lamellar Keratitis Associated with Bleeding during Femtosecond Laser-assisted Small-Incision Lenticule Extraction

Purpose: To report a case of diffuse lamellar keratitis (DLK) associated with bleeding during femtosecond laser-assisted small-incision lenticule extraction (SMILE).Case summary: A 29-year-old woman underwent bilateral SMILE surgery. After creation of the corneal lenticule and incision using a femtosecond laser in the left eye, bleeding at the incision site was observed. Although bleeding was controlled with gentle pressure using a sponge, minor bleeding from a new corneal vessel was introduced into the corneal pocket during lenticule separation. Pocket irrigation was performed to remove the blood content at the conclusion of surgery. Two days postoperatively, stage I DLK was observed at the corneal interface. Aggressive treatment with topical steroids (administered every 2 hours) was initiated, and the DLK completely resolved by postoperative week one.Conclusions: DLK can occur in association with bleeding from a new corneal vessel during SMILE. Attention should be paid when performing SMILE in eyes with new corneal vessels at the incision site.