Abstract
PURPOSE:
This study aims to report a case of HSV keratitis post-Descemet’s stripping automated endothelial keratoplasty (DSAEK)
METHODS:
A 69-year-old male presented with right eye defective vision in the last 1 year. He had poor visual recovery after he underwent cataract surgery 1 year ago. On examination, he had an old Descemet membrane detachment with a taut membrane.
He underwent RE DSAEK, on postoperative day 15 he came with complaints of foreign body sensation, and he was diagnosed with HSV Epithelial keratitis. Topical steroids were stopped and topical antiviral and cycloplegics were given. He reviewed back to us after 2 days with a large central geographic ulcer, therapeutic dose of oral acyclovir was added to his treatment regimen. He reviewed back on post-operative day 25 even though the geographic ulcer had reduced in size but, he had developed a central anterior to mid stromal whitish infiltrate- a diagnosis of HSV necrotising stromal keratitis was made and he was continued on topical and oral antivirals. On postoperative day 36, the geographic ulcer had reduced to 60% of its original size- topical steroids, oral antivirals, and topical cycloplegics were given. On his follow-up visit after 3 days (postoperative day 39)- the epithelial defect had heaped up margins with a resolving anterior stroma infiltrate, here a diagnosis of meta herpetic ulcer was made. He underwent an amniotic membrane transplant and tarsorrhaphy on the same day. On postoperative day 1 month 14 days Amniotic membrane graft (AMG) was well integrated, anterior to mid stromal corneal scar was noted lenticule was well attached, here slow steroid taper was advised, with a prophylactic dose of oral acyclovir.
CONCLUSION:
We successfully managed a case of HSV keratitis post-DSAEK, HSV keratitis can develop following keratoplasty even in the absence of a previous history of infection, hence early clinical suspicion and medical management can allow complete resolution of infection with scarring.
There are very few case reports of HSV keratitis after endothelial keratoplasty in literature and according to our knowledge, there are no previous case reports of HSV NSK after DSAEK.