Diffuse lamellar keratitis after kerato-refractive lenticule extraction: A case report and systematic review of published cases

PURPOSE: This paper aims to present a rare case of diffuse lamellar keratitis (DLK) following kerato-refractive lenticule extraction (KLEx) surgery and to provide a comprehensive review of all reported cases. METHODS: In this case report, we present a 27-year-old patient who developed stage 3 DLK following KLEx surgery by SmartSight. The condition was managed with an interface washout using balanced salt solution and an intensive topical corticosteroid regimen. Additionally, we conducted a systematic review of published cases of KLEx-related DLK up to June 2025. RESULTS: Clinical symptoms and slit-lamp findings showed significant improvement three days after the interface washout. By day six, the cornea appeared clear with resolution of the inflammation. CONCLUSION: KLEx-related DLK is a rare complication that usually presents within 1-2 days postoperatively, with common symptoms such as blurred vision and ocular discomfort. Management strategies, including topical corticosteroids and interface washout in selected cases, can lead to favorable visual outcomes.