Wessely corneal ring after keratorefractive lenticule extraction: case report of atypical diffuse lamellar keratitis

Introduction: This case report describes a rare presentation of a Wessely corneal ring outside the surgical zone and diffuse lamellar keratitis (DLK) after keratorefractive lenticule extraction (KLEx). The importance of recognizing and managing noninfectious immune responses after KLEx is discussed. Patient and Clinical Findings: A patient developed mild foreign body sensation, photophobia, and ciliary injection on postoperative day 2 after KLEx in the right eye. Slit-lamp showed an annular gray-white infiltrate in the inferotemporal peripheral cornea with intact epithelium, accompanied by scattered granular deposits at the surgical interface. Anterior segment optical coherence tomography imaging localized the lesions to the limbal area, external to the laser ablation zone. Diagnosis, Intervention, and Outcomes: The patient was diagnosed with an atypical DLK accompanied by the Wessely corneal ring. Management with bandage contact lens, interface washout, and intensive topical steroids achieved infiltrate resolution. Negative cultures and stains excluded infection. After a month of follow-up, the infiltrate had resolved mostly and nearly restored corneal transparency. Conclusions: This case highlights the importance of differentiating noninfectious immune reactions, such as DLK and Wessely rings, from infectious keratitis after KLEx surgery. Aggressive topical corticosteroid therapy combined with interface irrigation is crucial to prevent progressive corneal infiltration and stromal melting.