Infection and Drug Resistance (Nov 2022)
Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series
Abstract
Lixiang Wang, Yingping Deng, Ke Ma, Hongbo Yin, Chengshu Sun, Jing Tang Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of ChinaCorrespondence: Jing Tang, Department of Ophthalmology, West China Hospital of Sichuan University, No.37, Guoxue Alley, Sichuan, People’s Republic of China, Tel +86 18980603835, Email [email protected]: Corneal crosslinking is widely applied to enhance corneal biomechanical properties and delay the progression of keratoconus. The surgical procedure and application of ultraviolet A irradiation (UVA) during corneal crosslinking have been recognized to induce the reactivation of simplex herpes virus (HSV) but are rarely reported and poorly analyzed.Case Presentation: We report the first case series of herpetic keratitis in 4 keratoconus patients undertaking corneal crosslinking, who were all clinically diagnosed at routine follow-up visits 3 days to 1 month after the surgery. Different from the typical new onset of secondary herpetic keratitis that mainly presents with epithelial lesions and severe eye pain, these patients all presented with stromal infiltrates and were generally asymptomatic except for vision blurring in 2 patients. All patients responded well to antiviral therapy, topical steroids, and epithelial nourishment medication, leaving corneal macula or nebula at the last follow-up visit.Conclusion: Close follow-up is essential and the most effective way to diagnose herpetic keratitis after corneal crosslinking due to the lack of subjective symptoms. The prophylactic use of antiviral therapy on asymptomatic patients is controversial and should be evaluated based on long-term prognosis.Keywords: simplex herpes virus, herpetic keratitis, keratoconus, corneal crosslinking, prophylactic antiviral therapy
