Retained Lens Fragment Mimicking Herpes Simplex Virus Endotheliitis: A Diagnostic Challenge Resolved With Descemet Membrane Endothelial Keratoplasty
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR252 | Type: Poster | DOI: 10.82333/kvzx-5r30
Authors: Dr Muhammad Ahmed 1 , Dr Muhammad Hamza* 2
1Opthalmology,Ziauddin Hospital,Karachi,Pakistan;Opthalmology,Ahmed Bhambha Eye Hospital,Karachi,Pakistan, 2Opthalmology,Liaquat National Hospital,Karachi,Pakistan;Opthalmology,University Hospital Southampton NHS Foundation Trust,Southampton,United Kingdom;Opthalmology,Shahzad Eye Hospital,Karachi,Pakistan
Purpose
To describe a case of retained lens fragment mimicking herpes simplex virus (HSV) endotheliitis and emphasize the importance of imaging and surgical intervention with Descemet membrane endothelial keratoplasty (DMEK).
Setting
Tertiary Care Eye Hospital
Methods
A 65-year-old hypertensive male with a history of uncomplicated bilateral cataract surgery presented with progressive visual decline in the left eye for one year. He had been treated as HSV endotheliitis with antivirals and corticosteroids for nine months without improvement. Anterior segment optical coherence tomography (AS-OCT) revealed retained lens fragments in the anterior chamber. The patient underwent fragment removal followed by DMEK.
Results
Preoperative best-corrected visual acuity (BCVA) was counting fingers. Postoperatively, BCVA improved to 6/16 with resolution of corneal edema and a clear graft. No recurrence of inflammation or graft rejection was observed during follow-up.
Conclusions
Retained lens fragments can mimic HSV endotheliitis and delay diagnosis. We report a 65-year-old hypertensive male with prior uncomplicated bilateral cataract surgery (2017) who presented with progressive visual decline in the left eye for one year. He was treated as presumed HSV endotheliitis with systemic and topical antivirals and corticosteroids for nine months without improvement. Further imaging revealed retained lens fragments. Surgical removal followed by DMEK led to marked corneal clearing and significant visual recovery, highlighting the importance of early suspicion and timely intervention.