To Report A Case Of Post- Photorefractive Keratectomy Herpetic Epithelial Viral Keratitis

Tertiary eye care hospital, New Delhi, India

A 24-year-old male patient underwent PRK in both eyes using Mel-90 excimer laser (Carl Zeiss Meditec, Jena, Germany), with post-operative UDVA 6/6 on Snellen visual acuity in both eyes on postoperative day 1. One week later he presented with sudden onset pain, redness, and loss of vision in the left eye. On examination, the uncorrected visual acuity was 6/24 UDVA on Snellen's visual acuity chart with a dendritic ulcer morphing into a geographic ulcer seen on a slit lamp examination of the cornea. The patient had no similar episodes in the past pre-operatively. Though there was a diagnostic dilemma of considering delayed or altered epithelial healing, we treated the case in the lines of herpetic epithelial viral keratitis.

The patient gradually resolved symptomatically on treatment with topical acyclovir 3% 5 times/ day up to 2 weeks, topical moxifloxacin hydrochloride 0.5% QID up to 2 weeks along with topical lubricants and oral acyclovir 400mg BD continued for 2 months after resolution of infection. The ulcer gradually reduced with minimal corneal scarring by 1 week post-treatment. Topical steroids that had been started in the post-PRK regime were also stopped in the left eye after the onset of the infection. The patient recovered a UDVA on 6/9 Snellen visual acuity 1 month after treatment regime was started on the resolution of infection. This was maintained up to 1 -year on follow-up without any episodes of recurrence.

Though there have only been rare case reports of new-onset cases of Herpes viral keratitis post-PRK, early detection and prompt management of such cases can help salvage the visual acuity in these cases.