J Korean Ophthalmol Soc.  2019 Jan;60(1):75-79. 10.3341/jkos.2019.60.1.75.

A Case of Herpes Simplex Keratitis after Descemet Membrane Endothelial Keratoplasty

• Hwang Y
• Cho YK

• KMID: 2431843
• DOI: http://doi.org/10.3341/jkos.2019.60.1.75

Abstract

PURPOSE
We report a case of herpes simplex keratitis after Descemet membrane endothelial keratoplasty (DMEK).
CASE SUMMARY
A 67-year-old male underwent DMEK in his left eye due to pseudophakic bullous keratopathy. One week after DMEK, re-bubbling was performed due to partial detachment of Descemet's membrane at the corneal periphery. After re-bubbling, the cornea remained clear and the patient's visual acuity gradually improved. Two months after DMEK, the patient presented with mild discomfort and decreased visual acuity. The cornea showed an irregular, narrow dendrite with an epithelial defect and surrounding opacity. After confirming that Descemet's membrane was attached, the patient was started on oral valacyclovir for suspected herpes keratitis. Herpes simplex virus type 1 was eventually identified by polymerase chain reaction. The corneal lesion resolved after three weeks of antiviral treatment.
CONCLUSIONS
Similar to penetrating keratoplasty, DMEK can trigger outbreaks of herpes simplex keratitis. Herpes simplex keratitis should remain on the clinician's differential diagnosis for patients who present with a corneal epithelial irregularity and decreased visual acuity following DMEK.

Keyword

Descemet membrane endothelial keratoplasty; Herpes; Valacyclovir

MeSH Terms

Aged
Cornea
Corneal Transplantation*
Dendrites
Descemet Membrane*
Diagnosis, Differential
Disease Outbreaks
Herpes Simplex*
Herpesvirus 1, Human
Humans
Keratitis
Keratitis, Herpetic*
Keratoplasty, Penetrating
Male
Polymerase Chain Reaction
Visual Acuity

Figure

• 

  Figure 1 Preoperative cornea at slit lamp examination. Edematous cornea by slit lamp microscopic examination. Diffuse linear descemet's membrane's folding and corneal thickening was observed.

• 

  Figure 2 Cornea after rebubbling. (A) Cornea in slit lamp examination one day after re-bubbling. (B) Pentacam scheimpflug image after re-bubbling. (C) Specular microscope image after re-bubbling. APEX = polymorphism; AVE = average cell area; NUM = cell number analyzed; CD = cell density; CV = coefficient of cell deviation; AREA = polymegathism.

• 

  Figure 3 Cornea at slit lamp examination. (A) slight edematous cornea. (B) faint irregularity in slit lamp examination with fluorescent stain.

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