Recurrent late diffuse lamellar keratitis induced by corneal dellen after significant LASIK-epithelial ingrowth

Introduction: The case reports a unique pathologic sequence of recurrent late diffuse lamellar keratitis (DLK) after epithelial ingrowth beneath lamellar in situ keratomileusis (LASIK) flap. Patient and Clinical Findings: A 70-year-old man with a history of myopic LASIK surgery and enhancement 20 years prior presented with unilateral decreased visual acuity, pain, redness, and tearing. On examination, whitish clumps (epithelial ingrowths) were evident in the corneal interface beneath a thick LASIK flap in the inferior cornea, and DLK was observed. The flap was irregular, with an evident epithelial defect (dellen). Laboratory cultures from the eroded area returned negative. Diagnosis, Intervention, and Outcomes: The patient was treated with resolving epithelial defect and DLK. However, the patient returned twice with the same clinical picture. His condition was diagnosed as recurrent DLK triggered by the corneal dellen secondary to the irregular cornea postepithelial ingrowth melt. His recurrences were treated successfully with topical lubrication and steroids. Conclusions: Epithelial ingrowth is an important complication after LASIK. This case demonstrates cardinal mechanisms resulting from epithelial ingrowth, including corneal melt, secondary dellen areas, resultant recurrent epithelial defect, and, consequently, DLK. The authors hope this case will provoke further clinical awareness of these findings in post-LASIK patients.