HSV Keratitis after Femtosecond Laser Assisted Cataract Surgery and Astigmatic Keratotomy: JCRS

Dr Timothy Chou from Renaissance School of Medicine at Stony Brook University, New York, USA and colleagues have reported a case of Herpes Simplex Virus Stromal Keratitis and Endothelitis after Femtosecond Laser Assisted Cataract Surgery (FLACS) and Laser Astigmatic Keratotomy.

The case report has been published in the Journal of Cataract and Refractive Surgery Online Case Reports.

A 72-year-old woman underwent uneventful FLACS in the right eye, combined with superonasal and inferotemporal FSAK incisions. Two weeks later, she developed pain and decreased vision in her operated eye. Slit lamp examination revealed ulceration and infiltration in the superonasal cornea, at one of the astigmatic keratotomy sites. There was associated dense fibrinous anterior chamber reaction. Empirical management with topical antibiotics and antifungals along with a low dose steroid was given. Over a period of a few weeks, the ulcer healed, but corneal inflammation and infiltration persisted.

The patient was referred to the Cornea Speciality Centre of the Stony Brook University for management of persistent keratitis. On examination, corrected distance visual acuity was 20/50. Corneal sensation was decreased. A thickened pannus was observed extending into the superonasal cornea but the epithelium was intact. This was associated with stromal thinning and Descemet folds radiating from the superonasal to central cornea. The folds were dotted with keratic precipitates. HSV Stromal Keratitis and Endothelitis was suspected based on clinical examination and unsuccessful response to topical fortified antibiotic and antifungal medications. Empirical management with topical steroids under the cover of oral anti-viral medication was started.