HERPETIC KERATITIS AFTER PTERYGIUM EXCISION

The surgical excision of the pterygium is a commonly performed procedure. Various types of complications have been reported. However, Herpetic keratitis (HK) after pterygium excision surgery occurs rarely. Apart from our case, few reports of keratitis after pterygium excision have been published. We report a new onset HK after pterygium removal combined with autograft.

Department of ophthalmology, University Mohammed VI of sciences and health, Rabat, Morocco.

We report the case of a 60-year-old woman presented with a history of a progressive reduction in visual acuity of the left eye (LE). The best corrected visual acuity was 1/10. Ophthalmologic examination disclosed the presence of a nasal pterygium grade 3 with the adhesion of the pterygium to the palpebral conjunctiva. The petrygium was excised under local anesthesia with conjunctival autograft and without the use of antimetabolies. At the end of the surgery, a combination therapy with dexamethasone0.1% and tobramycin0.3% eye drop was given and the left eye was patched.

One week after the surgery, the patient complained of pain in the LE. On slit lamp examination, the LE showed a corneal ulcer surrouded by stromal edema with a superficial neovascularization. The ocular and medical histories were unremarkable. The patient was started on tablet valacyclovir 1g three times daily. Tobramycin and dexamethasone eye drops were withdrawn. On day 5 of therapy, the epithelial defect had completely healed. The clinical diagnosis of HK was confirmed by polymerase chain reaction. Topical corticosteroid drops and perervative-free lubricant were added to the treatment. Over the following week, a significant decrease in stromal edema and corneal neovascularization were observed. One episode of HK recurrency was noted during follow-up.

This case highlights the risk of HK after pterygium excision and elucidates the importance of timely diagnosis and management of this unusual  but important complication. In this case, the patient had no history of ocular herpes, but a recurrent herpetic labialis was noted. Those data shows that a lack of known herpetic disease should not preclude a diagnosis of HK. Herpetic keratitis after pterygium excision could be attributed to various factors including reactivation of latent infection secondary to surgical trauma to the cornal subepithelial nerve plexus and the modulation of the ocular immune response in the postoperative period caused by corticosteroids.