Diffuse lamellar keratitis or sometimes called “Sands of the Sahara Syndrome” is a complication following LASIK surgery. Diffuse lamellar keratitis appears as inflammatory infiltrates inside the corneal flap interface. It is a non-infectious process. The infiltrates appear as fine white dots in the corneal flap interface.
What Causes Diffuse Lamellar Keratitis?
The exact cause for diffuse lamellar keratitis is still not known at this time. The stimulus for the development of the deposition of inflammatory cells has been studied extensively. Many theories have been proposed such as:
Secretions from meibomian glands
Foreign material in the tear film
Red blood cells left in the corneal interface
Fibers from weck cell sponges
Residual residue on the surgical instruments
Symptoms of Diffuse Lamellar Keratitis
Symptoms begin to occur shortly following LASIK surgery. Patients may complain of pain, blurred vision, light sensitivity (photophobia), irritation, foreign body sensation, tearing, and redness of the eye.
Clinical Course and Presentation of Diffuse Lamellar Keratitis
Diffuse lamellar keratitis may occur in approximately one to four percent of LASIK procedures. There have been eye doctors that have had a series of episodes of cases close together which suggests some type of reaction to a foreign substance.
Diffuse lamellar keratitis using begins one or two days after LASIK surgery and is divided into four stages.
DLK typically begins one to two days after LASIK surgery and is characterized by peripheral inflammatory cells and does not involve the central cornea.
DLK typically begins three or four days after LASIK surgery and is characterized by the inflammatory cells developing in the central cornea as well. These patients may have blurred vision.
The DLK has more central inflammatory cells resulting in permanent corneal scarring with loss of vision.
The DLK has progressed to the point of corneal melting and more severe scarring and more loss of vision.
Treatment of Diffuse Lamellar Keratitis
Treatment of diffuse lamellar keratitis consists of topical corticosteroid medication. In the severe cases, the corneal flap is lifted up. The interface is cleaned and thoroughly irrigated with sterile solution and the flap replaced. Most cases if found early and treated do well without loss of vision.