A Case of Herpes Simplex Keratitis after Descemet Membrane Endothelial Keratoplasty

Yousook Hwang; Yang Kyung Cho

doi:10.3341/jkos.2019.60.1.75

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Hwang and Cho: A Case of Herpes Simplex Keratitis after Descemet Membrane Endothelial Keratoplasty

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(1): 75-79.

Published online: 16 January 2019

DOI: https://doi.org/10.3341/jkos.2019.60.1.75

A Case of Herpes Simplex Keratitis after Descemet Membrane Endothelial Keratoplasty

Yousook Hwang, MD, Yang Kyung Cho, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to Yang Kyung Cho, MD, PhD. Department of Ophthalmology and Visual Science, The Catholic University of Korea St. Vincent's Hospital, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: 82-31-249-7340, Fax: 82-31-251-6225, yangkyeung@hanmail.net

Received 31 May 2018 Revised 26 July 2018 Accepted 28 December 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Descemet membrane endothelial keratoplasty, Herpes, Valacyclovir

Figures and Tables

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.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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