Postoperative Herpetic Keratitis Following Cataract Surgery In A Patient With Acute Angle-Closure

The purpose of this study is to highlight the risk factors, diagnosis, and management of postoperative herpetic keratitis in a patient treated for primary acute angle-closure and subsequently undergoing cataract surgery.

This study was prepared based on the clinical findings, observations, and management of a patient admitted to Dışkapı Yıldırım Beyazıt Training and Research Hospital in August 2025 with suspected primary acute angle-closure, who subsequently developed herpetic keratitis following cataract surgery.

A patient presented to our clinic with decreased vision and ocular pain in the left eye and was admitted with a diagnosis of primary acute angle-closure. Intraocular pressure (IOP) was reduced with medical therapy, and corneal edema decreased, allowing a peripheral iridectomy to be performed. The following day, peripheral iridectomy was also performed in the fellow eye. During follow-up, despite the use of topical antiglaucomatous drops, the left eye continued to have elevated IOP, a narrow anterior chamber, and a nuclear cataract, and cataract surgery was therefore planned for the left eye.

On the third postoperative day after cataract surgery, an epithelial defect was observed in the cornea. With the addition of artificial tears to the treatment, the defect healed within a few days, and the patient was discharged. At the 15th postoperative day follow-up, examination revealed a geographic corneal ulcer. Herpetic keratitis was suspected, and antiviral therapy was initiated.

Herpetic keratitis is an important vision-threatening complication that can occur after cataract surgery. In this case, risk factors included stressors such as acute angle-closure and cataract surgery, the postoperative use of topical eye drops containing dexamethasone and latanoprost, and the presence of chronic systemic diseases including diabetes mellitus, hypertension, and rheumatoid arthritis. Considering these risk factors, careful history-taking and thorough ophthalmic examination are essential for early diagnosis and timely treatment, which are critical for controlling this potentially severe postoperative complication.