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Herpetic Keratitis after Corneal Collagen Cross-Linking with Riboflavin and Ultraviolet-A for Keratoconus.

Al-Qarni A, AlHarbi M - Middle East Afr J Ophthalmol (2015 Jul-Sep)

Bottom Line: The corneal sensation was significantly diminished compared to the fellow eye.Herpetic keratitis could be induced by CXL even in patients with no history of previous herpetic eye disease.Early diagnosis and proper treatment can facilitate the successful management of this rare but important complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, P. O. Box 7191, Riyadh 11462, Saudi Arabia.

ABSTRACT
To describe two cases of herpetic keratitis after corneal collagen cross-linking (CXL) for progressive keratoconus. An 18-year-old male and a 21-year-old male with rapidly progressive keratoconus were treated with CXL. Postoperatively, on the 6(th) and 9(th) days respectively, a dendritic ulcer was observed in the treated eye. The corneal sensation was significantly diminished compared to the fellow eye. Both patients had no prior history of herpetic eye disease or cold sores. The keratitis improved dramatically over the following days after initiation of antiviral therapy. At 4 months, the visual acuity was stable without corneal scarring. Herpetic keratitis could be induced by CXL even in patients with no history of previous herpetic eye disease. Early diagnosis and proper treatment can facilitate the successful management of this rare but important complication.

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Mild corneal haze after 4 months of treatment
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Figure 2: Mild corneal haze after 4 months of treatment

Mentions: The same procedure was repeated after 3 months for the left eye. On the 5th day, slow re-epithelialization was observed. On the 7th postoperative day, the patient presented with a geographic epithelial defect with dendritic edges without iritis. Corneal sensation was decreased in comparison to the right eye. Topical corticosteroid was discontinued, and the patient was started on ganciclovir (Virgan gel, 1.5 mg/g; Thea Pharma, Wetteren, Belgium) five times daily for 2 weeks then three times daily for 2 weeks. After 2 days of initiation of topical antiviral therapy, the geographic ulcer dramatically improved and re-epithelialized [Figure 1]. Topical corticosteroid drops were resumed after healing of the epithelial defect. All medications were slowly tapered over the following weeks. Four months later, a mild central corneal opacity remained but the UCVA recovered to preoperative levels without any recurrence of keratitis [Figure 2].


Herpetic Keratitis after Corneal Collagen Cross-Linking with Riboflavin and Ultraviolet-A for Keratoconus.

Al-Qarni A, AlHarbi M - Middle East Afr J Ophthalmol (2015 Jul-Sep)

Mild corneal haze after 4 months of treatment
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4502188&req=5

Figure 2: Mild corneal haze after 4 months of treatment
Mentions: The same procedure was repeated after 3 months for the left eye. On the 5th day, slow re-epithelialization was observed. On the 7th postoperative day, the patient presented with a geographic epithelial defect with dendritic edges without iritis. Corneal sensation was decreased in comparison to the right eye. Topical corticosteroid was discontinued, and the patient was started on ganciclovir (Virgan gel, 1.5 mg/g; Thea Pharma, Wetteren, Belgium) five times daily for 2 weeks then three times daily for 2 weeks. After 2 days of initiation of topical antiviral therapy, the geographic ulcer dramatically improved and re-epithelialized [Figure 1]. Topical corticosteroid drops were resumed after healing of the epithelial defect. All medications were slowly tapered over the following weeks. Four months later, a mild central corneal opacity remained but the UCVA recovered to preoperative levels without any recurrence of keratitis [Figure 2].

Bottom Line: The corneal sensation was significantly diminished compared to the fellow eye.Herpetic keratitis could be induced by CXL even in patients with no history of previous herpetic eye disease.Early diagnosis and proper treatment can facilitate the successful management of this rare but important complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, P. O. Box 7191, Riyadh 11462, Saudi Arabia.

ABSTRACT
To describe two cases of herpetic keratitis after corneal collagen cross-linking (CXL) for progressive keratoconus. An 18-year-old male and a 21-year-old male with rapidly progressive keratoconus were treated with CXL. Postoperatively, on the 6(th) and 9(th) days respectively, a dendritic ulcer was observed in the treated eye. The corneal sensation was significantly diminished compared to the fellow eye. Both patients had no prior history of herpetic eye disease or cold sores. The keratitis improved dramatically over the following days after initiation of antiviral therapy. At 4 months, the visual acuity was stable without corneal scarring. Herpetic keratitis could be induced by CXL even in patients with no history of previous herpetic eye disease. Early diagnosis and proper treatment can facilitate the successful management of this rare but important complication.

Show MeSH
Related in: MedlinePlus