J Korean Ophthalmol Soc.  2012 Mar;53(3):473-477.

A Case of Herpes Simplex Keratitis after Descemet Stripping Automated Endothelial Keratoplasty

• Jeong SH
• Cho JK
• Yoon KC

Abstract

PURPOSE
To report a case of herpes simplex keratitis after descemet stripping automated endothelial keratoplasty (DSAEK).
CASE SUMMARY
A 66-year-old male underwent DSAEK in his right eye due to bullous keratopathy after cataract surgery. The corneal epithelium which was removed during surgery was healed, but the patient was experiencing pain and decreased visual acuity in his right eye 1 month after surgery. Increasing corneal epithelial defects and corneal edema were observed on slit-lamp examination. Therapeutic soft contact lenses and artificial tears were used for treatment but were not effective, thus amniotic membrane transplantation was performed. Three months after transplantation, the epithelial defect appeared as a geographic ulcer suspecting to be herpes simplex keratitis; therefore, ganciclovir ophthalmic ointment and oral acyclovir were administered. Six months after antiviral therapy, the epithelial lesion of herpes simplex keratitis completely disappeared, leaving only mild corneal opacity.
CONCLUSIONS
If corneal epithelial defects are persistent after DSAEK in patients even with no past history of herpes simplex keratitis, herpes simplex keratitis should be considered in the differential diagnosis.

Keyword

DSAEK; Ganciclovir; Herpes

MeSH Terms

Acyclovir
Aged
Amnion
Cataract
Contact Lenses, Hydrophilic
Corneal Edema
Corneal Transplantation
Diagnosis, Differential
Epithelium, Corneal
Eye
Ganciclovir
Herpes Simplex
Humans
Keratitis, Herpetic
Male
Methylmethacrylates
Ophthalmic Solutions
Polystyrenes
Transplants
Ulcer
Visual Acuity
Acyclovir
Ganciclovir
Methylmethacrylates
Ophthalmic Solutions
Polystyrenes

Figure

• 

  Figure 1 Slit-lamp photographs in a patient who received descemet stripping automated endothelial keratoplasty (DSAEK). (A) Before DSAEK, pseudophakic bullous keratopathy was visible in the right eye. (B) One week after surgery, the transplanted endothelial graft was well positioned, and corneal epithelium completely healed. (C) One month after surgery, corneal epithelial defects with mild corneal edema were detected. (D) Two months after amniotic membrane transplantation, the size of epithelial defects increased. (E) Three months after amniotic membrane transplantation, geographic epithelial ulceration appeared. (F) Six months after antiviral treatment, the corneal epithelial lesion completely healed with mild corneal haze.

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