Noninfectious Inflammatory Complications of Lamellar Refractive Corneal Surgery: A Review of Diffuse Lamellar Keratitis, Central Toxic Keratopathy, and Transient Light Sensitivity Syndrome

Laser vision correction through lamellar refractive corneal surgery, such as laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE), have increased in popularity given new technologies and increased patient preference for corrective lens independence. However, these surgeries are not without potential postoperative complications. Diffuse lamellar keratitis (DLK), central toxic keratopathy (CTK), and transient light sensitivity syndrome (TLSS) comprise 3 rare, noninfectious, inflammatory complications after corneal lamellar refractive surgery that differ in their clinical presentation. DLK has the most potentially severe vision-threatening outcomes and is associated with clinical findings of white, granular cells in the stromal interface. CTK is associated with the triad of central corneal opacification, central striae, and hyperopic shift. TLSS has no findings on slit lamp examination. While both DLK and TLSS are responsive to topical steroids, CTK improves without intervention. It is important to distinguish the 3 syndromes, as proper diagnosis may provide insight into the underlying cause of the patient's symptoms and thus guide treatment.