Diffuse lamellar keratitis after femtosecond laser refractive lenticule extraction

We report 6 eyes (spherical refraction from −4.0 to −10.0 diopters) in 4 cases of diffuse lamellar keratitis (DLK) after femtosecond laser refractive lenticule extraction. A refractive lenticule was created using a femtosecond laser and then extracted through a 3.0 mm incision (5 eyes without a flap) and an approximately 20.0 mm incision (1 eye, flap thickness 100 μm). On the first postoperative day, Case 1 developed bilateral DLK (stage 1), Case 2 developed DLK (stage 2) with a small tear at the incision edge, Case 3 developed bilateral DLK (stage 2 in the right eye, stage 1 in the left eye). Case 4 developed late-onset DLK (stage 2) after 5 months. All cases were treated adequately with topical steroids and resolved completely without progression; no visual acuity loss occurred. The DLK may have occurred after refractive lenticule extraction. It is important to diagnose and treat timely and appropriately to avoid vision loss. No author has a financial or proprietary interest in any material or method mentioned.