Herpetic Keratitis After Yamane Technique In Patient Without Prior Herpes Infection History

This case highlights the recurrence of herpetic keratitis following ocular surgery in a patient with no documented history of HSV infection. Specifically, it underscores the occurrence of this rare complication after sutureless scleral intraocular lens fixation using the Yamane technique.

Ophthalmology Department ,  Military University Regional Hospital, Oran, Algeria

Oran University 1 , Faculty of Medicine .

A 65-year-old woman was referred to our department for the correction of aphakia without capsular support,sutureless scleral intraocular lens IOL with PVDF fixation using the Yamane technique under local anesthesia was done.  A 2.8 mm corneal incision was created at 12 o’clock, with two paracenteses at 11 and 1 o’clock. Central anterior and peripheral vitrectomy were performed. The IOL was injected in the anterior chamber through the 2.8 mm incision, and the haptics were fixated to the sclera using two thin-walled 30-gauge needles at 02 mm from the limbes at 180° .The surgery was completed without complications.. Five days postoperatively, the patient’s vision was 20/32, and the cornea was clear. However, 10 days  later, she presented to the emergency department with complaints of ocular redness, pain, and decreased vision to 20/100 . Clinical examination revealed corneal ulceration with stromal involvement,and decreased  corneal sensitivity. Based on these findings, a diagnosis of recurent herpetic keratitis was suspected despite the absence of a known history of herpes simplex virus (HSV) infection. The patient was treated with systemic acyclovir (15 mg/kg/day) for 15 days, followed by oral acyclovir as maintenance therapy, cicatrizing agents, and topical antibiotics was prescribed. After 20 days of treatment, the corneal ulceration healed, corneal opacity improved, and symptoms resolved. 05 weeks later  on the patient recovre her vision to 20/50 and cornea beacame clear.

This case highlights a rare postoperative complication of HSV keratitis following IOL fixation with the Yamane technique. Prompt recognition and targeted antiviral therapy led to a favorable clinical outcome. Clinicians should consider viral reactivation as a potential cause of postoperative inflammation even  in patients without noticeable history of HSV infection.