CASE REPORT: “ARCHIPELAGO KERATITIS”, AN UNUSUAL VARIANT OF RECURRENT HERPETIC KERATITIS

Published 2023 - 27th ESCRS Winter Meeting

Reference: P113 | Type: Presented Poster & Poster Submission | DOI: 10.82333/p4pj-f579

Authors: Adrian Robles Garcia* ¹ , Yolanda fernandez barrientos ¹ , Encarnación Jiménez Rodríguez ¹ , Szymon Gluszko ¹ , Esperanza Ramírez Moreno ¹ , Rafael Luque Aranda ¹

¹Hospital Virgen de la Victoria de Málaga,Malaga,Spain

Purpose

To share our experience regarding the diagnostic challenge and management represented by this atypical and uncommon manifestation of herpetic keratopathy

Setting

Hospital Universitario Virgen de la Victoria, Málaga, Spain

Methods

Description of a case diagnosed and treated in our ophthalmology service

Results

A 39-year-old man came to the emergency room for a 5-days history of ocular hyperemia, foreign body sensation, and blurred vision in the right eye lasting 5 days. As background, the patient reported having been diagnosed with two corneal ulcers in the same eye seven years ago, which were resolved with eye ointment. He was not a contact lens wearer. As a medical history, he referred severe protein-calorie malnutrition stood out, secondary to a traffic accident polytrauma 4 months ago. Ophthalmological examination revealed Snellen best-corrected visual acuity of 20/80 in the right eye and 20/20 in the left eye. Slit-lamp examination revealed in the right eye, moderate diffuse conjunctival hyperemia, with several paracentral epithelial defects with positive fluorescein staining, nummular subepithelial inflammatory infiltrates arranged in a centripetal radial pattern, fine retro-keratic precipitates, without Tyndall, and small area of superior superficial neovascularization. Intraocular pressure was 15 mmHg in both eyes. The patient was initially on topical tobramycin and ciprofloxacin treatment. After 48 hours with no improvement, the patient was re-evaluated in the cornea unit. An “archipelago keratitis” (ApK) was diagnosticated and treated with topical aciclovir and fluorometholone, and oral valacyclovir 3g/day. After one week of follow-up, a notable improvement in symptoms was found, and partial improvement in vision. Slit-lamp exploration showed that the epithelial defects had already closed, and a decrease in subepithelial inflammatory infiltrates was observed, and finally disappeared after 3 weeks of follow-up. The final Snellen best-corrected visual acuity of the affected eye was 20/25.

A recurrence of ApK, was diagnosticated 7 months after, with a favorable response to antiviral therapy, for avoid another recurrence prolonged antiviral therapy and topical immunosuppression were employed.

Conclusion

ApK is an atypical form of Herpesviridae keratitis, which must be known to ophthalmologists, to avoid diagnostic delays and the resulting corneal scarring. Topical ciclosporin can be useful to avoid corticosteroid-dependent recurrence.