Here are two Stage IV DLK that resolved, one sponatneously, and one without stage noted (obviously Stage III DLK) but resolved after 16 months. Yes, the scaring can be permanent, but is not always.
These abstracts include other issues, such as a lost flap, subclinical haze, different meds, etc., but they show that even bad DLK scaring can resolve to where it no longer interferes with vision. That does not mean that you won't need treatment such as PTK or Mitomycin C, but it is a possibility.
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Journal of Refractive Surgery, 2007 Jun;23(6):625-7.
Repositioning of free cap four days after LASIK.Cheng AC, Wong VW, Rao SK, Lam DS.
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
PURPOSE: To report management and outcome of late repositioning of flap dislodgement after LASIK. METHODS: A 27-year-old man underwent LASIK in the right eye for correction of myopia, which was complicated by free cap. The flap was repositioned, but dislodged 2 days later. The dislodged flap was stored in balanced salt solution for 48 hours and repositioned 4 days after initial surgery. RESULTS: Postoperatively, the flap remained apposed, but
diffuse lamellar keratitis and epithelial ingrowth developed, which was managed with topical steroids and topical mitomycin C. Stromal haze gradually decreased by 16 months postoperatively, resulting in best spectacle-corrected visual acuity of 20/20. CONCLUSIONS: Flap dislodgement > 48 hours postoperatively can be repositioned with good visual outcome. The flap should be preserved in the event of such complication.
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Journal of Cataract and Refractive Surgery, 2006 Feb;32(2):353-6.
PubMed
Stage 4 diffuse lamellar keratitis after laser in situ keratomileusis Clinical, topographical, and pachymetry resolution 5 years later.
Michieletto P, Balestrazzi A, Balestrazzi A, Alegente M, Boccassini B.
Ophthalmic Hospital, Rome, Italy.
In March 1999, a 35-year-old woman had uneventful laser in situ keratomileusis in both eyes on the same day. Five days postoperatively, slitlamp biomicroscopy of the left eye showed an appearance similar to haze after photorefractive keratectomy, with greater density at the center and striae convergent toward the infiltrate (stage 4 diffuse lamellar keratitis [DLK]). The patient received treatment with dexamethasone 0.2% eyedrops every 2 hours. After 2 weeks, visual acuity was better and improvement was evident on topography, pachymetry, and slitlamp photography.
The improvements were more marked at 6 months and 1 year. There was a progressive increment in corneal thickness and consequent improvement in corneal transparency, curvature, and regularity. This case, in which continuous morphologic adaptation of the cornea occurred, indicates that observation, rather than intervention, is a valid therapeutic option for stage 4 DLK.
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Journal of Refractive Surgery, 2004 Jul-Aug;20(4):391-6.
PubMed
Confocal microscopy of stage 4 diffuse lamellar keratitis with spontaneous resolution.
De Rojas Silva MV, Díez-Feijóo E, Rodríguez-Ares MT, Sánchez-Salorio M.
Fundación Instituto Galego de Oftalmoloxía, Complexo Hospitalario Universitario de Santiago, University of Santiago, Santiago de Compostela, Spain.
PURPOSE: To report confocal microscopic findings at the onset of stage 4 diffuse lamellar keratitis and after its resolution. Stage 4 is the most severe form of diffuse lamellar keratitis. Its incidence is approximately 1 in 5000 and is associated with stromal melting, deep flap folds, central haze, hyperopic shift, irregular astigmatism, and severe decrease in visual acuity. METHODS: A 22-year-old woman underwent bilateral uncomplicated laser in situ keratomileusis (LASIK) for myopia. Postoperative course in the right eye was uneventful; however, in the left eye, stage 4 diffuse lamellar keratitis developed. Confocal microscopy examination was performed in both eyes at the onset of the syndrome and after its resolution. Findings in the eye with diffuse lamellar keratitis (left eye) were compared with the uninvolved (right) eye. RESULTS:
The condition improved spontaneously and 2 years later, slit-lamp microscopy showed resolution of the folds and haze with subsequent improvement of visual acuity. However, confocal microscopic examination in the left eye revealed a persistent stromal subclinical haze on both sides of the lamellar cut and prominent folds that extended into the anterior stroma. CONCLUSION: Confocal microscopy revealed that in spite of normal appearance on slit-lamp microscopy, micromorphological alterations persisted after spontaneous resolution of stage 4 diffuse lamellar keratitis.