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A case of herpetic keratitis after subconjunctival triamcinolone acetonide injection.

Inoue H, Suzuki T, Joko T, Inoue T, Ohashi Y - Case Rep Ophthalmol (2014)

Bottom Line: Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR.Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started.The inflammation subsided with this medication.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Ehime University, Graduate School of Medicine, Toon, Japan.

ABSTRACT

Purpose: We report a case of herpetic epithelial keratitis that developed after subconjunctival triamcinolone acetonide injection (STI).

Methods: A 65-year-old female with anterior uveitis and hypotony in her right eye was given a STI (2 mg/0.5 ml). After the injection, she developed redness and an ocular discharge. A clinical examination was performed and real-time polymerase chain reaction (PCR) was used to amplify the viral DNA in a corneal scraping.

Results: Slit-lamp biomicroscopy revealed a severe purulent discharge, conjunctival injection, and a geographic corneal ulcer in the right eye. Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR. Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started. The inflammation subsided with this medication.

Conclusion: We encountered a case of herpetic epithelial keratitis after a STI.

No MeSH data available.


Related in: MedlinePlus

A photograph showing blepharitis with vesicles of the lid margin and conjunctival injection.
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Figure 1: A photograph showing blepharitis with vesicles of the lid margin and conjunctival injection.

Mentions: A 65-year-old female who had diabetes mellitus visited a private clinic and presented with injection and visual disturbance in her right eye. Anterior uveitis was diagnosed, and she was referred to our hospital. Slit-lamp biomicroscopy revealed scleral injection, inflammatory cells in the anterior chamber as well as iris synechiae. The IOP in the right eye was 4 mm Hg and B-scan ultrasonography showed choroidal detachment. The patient did not have a history of herpetic eye disease. We diagnosed noninfectious anterior uveitis and began steroid treatment with a 0.1% dexamethasone ophthalmic solution every hour, 1% atropine eye drops every night, and oral prednisolone 25 mg/day. One month after treatment, the inflammation in the anterior chamber and choroidal detachment subsided while the IOP increased to 15 mm Hg. In addition, her blood sugar increased due to the adverse effects of oral prednisolone. Therefore, the systemic steroid was tapered and we continued topical steroids. The scleral injection, hypotony, and choroidal detachment reappeared after tapering the systemic steroids. We performed STI to reduce the anterior segment inflammation. She complained of redness, foreign body sensation, and ocular discharge 1 week after STI. Slit-lamp biomicroscopy showed conjunctival injection, discharge, blepharitis with vesicles of the lid margin, and geographic corneal and conjunctival epithelial defects (fig. 1, fig. 2). The patient was suspected of having herpetic keratitis. The topical steroid was stopped and she was treated with topical acyclovir (3% eye ointment 5 times/day) and oral valacyclovir (3,000 mg/day). Real time polymerase chain reaction (PCR) of a corneal scraping was performed in order to detect a potential human herpes virus, including herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, Epstein–Barr virus, cytomegalovirus, and human herpes viruses 6, 7, and 8. The real-time PCR results were positive only for HSV DNA (3×109 copies/sample). Since the conjunctival injection and epithelial defect improved with the therapy, the valacyclovir was tapered within 1 month. The scleritis and the inflammation in the anterior chamber as well as her herpetic keratitis were controlled with topical acyclovir. However, the hypotony persisted and the cataract progressed markedly. Therefore, a lensectomy and vitrectomy with silicone oil tamponade was performed and the IOP increased to 10 mm Hg. Thereafter, the patient was administered topical acyclovir and steroids, without any uveitis recurrence.


A case of herpetic keratitis after subconjunctival triamcinolone acetonide injection.

Inoue H, Suzuki T, Joko T, Inoue T, Ohashi Y - Case Rep Ophthalmol (2014)

A photograph showing blepharitis with vesicles of the lid margin and conjunctival injection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4209261&req=5

Figure 1: A photograph showing blepharitis with vesicles of the lid margin and conjunctival injection.
Mentions: A 65-year-old female who had diabetes mellitus visited a private clinic and presented with injection and visual disturbance in her right eye. Anterior uveitis was diagnosed, and she was referred to our hospital. Slit-lamp biomicroscopy revealed scleral injection, inflammatory cells in the anterior chamber as well as iris synechiae. The IOP in the right eye was 4 mm Hg and B-scan ultrasonography showed choroidal detachment. The patient did not have a history of herpetic eye disease. We diagnosed noninfectious anterior uveitis and began steroid treatment with a 0.1% dexamethasone ophthalmic solution every hour, 1% atropine eye drops every night, and oral prednisolone 25 mg/day. One month after treatment, the inflammation in the anterior chamber and choroidal detachment subsided while the IOP increased to 15 mm Hg. In addition, her blood sugar increased due to the adverse effects of oral prednisolone. Therefore, the systemic steroid was tapered and we continued topical steroids. The scleral injection, hypotony, and choroidal detachment reappeared after tapering the systemic steroids. We performed STI to reduce the anterior segment inflammation. She complained of redness, foreign body sensation, and ocular discharge 1 week after STI. Slit-lamp biomicroscopy showed conjunctival injection, discharge, blepharitis with vesicles of the lid margin, and geographic corneal and conjunctival epithelial defects (fig. 1, fig. 2). The patient was suspected of having herpetic keratitis. The topical steroid was stopped and she was treated with topical acyclovir (3% eye ointment 5 times/day) and oral valacyclovir (3,000 mg/day). Real time polymerase chain reaction (PCR) of a corneal scraping was performed in order to detect a potential human herpes virus, including herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, Epstein–Barr virus, cytomegalovirus, and human herpes viruses 6, 7, and 8. The real-time PCR results were positive only for HSV DNA (3×109 copies/sample). Since the conjunctival injection and epithelial defect improved with the therapy, the valacyclovir was tapered within 1 month. The scleritis and the inflammation in the anterior chamber as well as her herpetic keratitis were controlled with topical acyclovir. However, the hypotony persisted and the cataract progressed markedly. Therefore, a lensectomy and vitrectomy with silicone oil tamponade was performed and the IOP increased to 10 mm Hg. Thereafter, the patient was administered topical acyclovir and steroids, without any uveitis recurrence.

Bottom Line: Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR.Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started.The inflammation subsided with this medication.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Ehime University, Graduate School of Medicine, Toon, Japan.

ABSTRACT

Purpose: We report a case of herpetic epithelial keratitis that developed after subconjunctival triamcinolone acetonide injection (STI).

Methods: A 65-year-old female with anterior uveitis and hypotony in her right eye was given a STI (2 mg/0.5 ml). After the injection, she developed redness and an ocular discharge. A clinical examination was performed and real-time polymerase chain reaction (PCR) was used to amplify the viral DNA in a corneal scraping.

Results: Slit-lamp biomicroscopy revealed a severe purulent discharge, conjunctival injection, and a geographic corneal ulcer in the right eye. Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR. Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started. The inflammation subsided with this medication.

Conclusion: We encountered a case of herpetic epithelial keratitis after a STI.

No MeSH data available.


Related in: MedlinePlus