Herpetic Endotheliitis Post Phacoemulsification – A Case Series

To highlight postoperative steroid can precipitate corneal edema after a period of absolute visual clarity in diabetic patients

Netralayam Superspeciality Eye Care Centre

Sunayan Advanced Eye Institute

This case series represents 18 patients who presented from March 2021 to January 2023 with decreased vision after uncomplicated phacoemulsification with Intraocular lens implantation. They all experienced a small postoperative window of good vision ranging from four to 20 days. The anterior segment Optical Coherence Tomography (ASOCT) revealed an intact Descemet membrane, increased corneal thickness and keratic precipitates in the endothelium. Based on clinical features and the ASOCT findings oral Acyclovir tablet five times/day was started and topical prednisolone acetate was continued six times/day. Nobody improved with this regimen in the first two weeks and five patients developed frank geographical keratitis. After starting topical Acyclovir ointment and stopping topical Prednisolone all of them improved within four to twelve weeks.

Conclusion

This case series considers herpetic endotheliitis as an important differential diagnosis in post-cataract surgery corneal edema, particularly if it develops after a period of absolute visual clarity and clear cornea in a diabetic patient. The appropriate timing to start a less potent topical steroid to combat inflammation under antiviral cover with close monitoring is the key to full recovery and improvement of visual acuity in these patients.