Case Report: Herpetic Keratitis After Cross-Linking Of Corneal Collagen With Riboflavin And Ultraviolet-A For Keratoconus In A Healthy 20-Year-Old Patient
Published 2023 - 41st Congress of the ESCRS
Reference: PO0609 | Type: Free paper | DOI: 10.82333/sxk7-1783
Authors: Ivana Radman* 1 , FREJA BAGATIN 1 , KARLA RANDJELOVIC 1 , IVANKA PETRIC VICKOVIC 1 , VALENTINA LACMANOVIĆ LONČAR 1 , RENATA IVEKOVIĆ 2 , ZORAN VATAVUK 3
1OPHTHALMOLOGY, ANTERIOR SEGMENT,UNIVERSITY HOSPITAL CENTRE "SESTRE MILOSRDNICE",ZAGREB,Croatia, 2OPHTHALMOLOGY, ANTERIOR SEGMENT AND OCULOPLASTIC ,UNIVERSITY HOSPITAL CENTRE "SESTRE MILOSRDNICE",ZAGREB,Croatia, 3OPHTHALMOLOGY, VITREORETINAL DEPARTMENT,UNIVERSITY HOSPITAL CENTRE "SESTRE MILOSRDNICE",ZAGREB,Croatia
Purpose
In this case report, we present patient who developed clinically diagnosed herpetic keratitis in the early postoperative period after CXL
Setting
A 20-year-old man referred to our Clinic because of bilateral keratoconus, stage III right eye and stage I-II left eye. There was no previous intraocular or corneal surgery, herpetic keratitis, autoimmune disease, or systemic connective tissue disease.
Methods
Uncorrected visual acuity (UCVA) was 0.09 in the right eye and 0.8 in the left eye. The best spectacle-corrected visual acuity (BSCVA) was 0.2 in the right eye and 1.0 in the left eye. An impression of slight corneal protrusion on both sides, one Vogt's stretch mark is visible paracentrally on the left. Topography showed inferior bilateral thinning. The recommended treatment was CXL with riboflavin and UV-A to stabilize the cornea. The patient underwent a thorough discussion of the risks and benefits of CXL with the surgeon and signed a written informed consent in accordance with institutional guidelines based on the Declaration of Helsinki
Results
On the fifth postoperative day, slow re-epithelialization was observed and the patient had a central dendritic epithelial defect. Local therapy included acyclovir in the form of ointment, continued antibiotic therapy, and oral therapy with acyclovir and vitamin B. Several subconjunctival injections DexaLido were applicated to the patient. Topical corticosteroid drops were continued after healing of the epithelial defect. Three months later, a central Vogt's striae was found, the rest of the ophthalmological status was normal. In therapy, maintenance oral therapy 1 tablet per day and corticosteroid 1x and artificial tears without preservatives 5-6x. We are planning to prescribe RK2 contact lenses.
Conclusions
Herpetic keratitis can be induced by CXL, even in cases with no history of herpetic eye disease.
Primary HSV keratitis often presents as a nonspecific upper respiratory tract infection and is recognized as HSV <5% of the time. Latent infection of the trigeminal ganglion may occur in the absence of a recognized primary infection, with reactivation occurring later as recurrent HSV infection in any branch of the trigeminal nerve.
Careful follow-up of patients after CXL seems to be important because early diagnosis and proper treatment can facilitate successful treatment of herpetic epithelial keratitis and prevent further possible consequences.