Fulminant herpetic keratouveitis with flap necrosis following laser in situ keratomileusis: Case report and review of literature

• Published in: Journal of cataract and refractive surgery Vol. 40; no. 12; pp. 2152 - 2156
• Main Authors: Arora, Tarun, MD, Sharma, Namrata, MD, Arora, Supriya, MS, Titiyal, Jeewan S., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: Acyclovir - analogs & derivatives; Acyclovir - therapeutic use; Administration, Oral; Adult; Antigens, Viral - immunology; Antiviral Agents - therapeutic use; Corneal Stroma - pathology; Corneal Stroma - virology; Female; Humans; Keratitis, Herpetic - diagnosis; Keratitis, Herpetic - drug therapy; Keratitis, Herpetic - etiology; Keratomileusis, Laser In Situ; Myopia - surgery; Necrosis; Ophthalmology; Postoperative Complications; Simplexvirus - immunology; Simplexvirus - isolation & purification; Surgical Flaps - pathology; Surgical Flaps - virology; Tomography, Optical Coherence; Uveitis, Anterior - diagnosis; Uveitis, Anterior - drug therapy; Uveitis, Anterior - etiology; Valine - analogs & derivatives; Valine - therapeutic use
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2014.09.018

A 25-year-old woman presented with redness, pain, and diminution of vision that occurred 2 weeks after microkeratome-assisted laser in situ keratomileusis (LASIK). On presentation, corneal edema, Descemet membrane folds, keratic precipitates, stromal infiltrates, and flap necrosis were observed. Delayed post-LASIK microbial keratitis was diagnosed. The patient had no history of ocular herpes. Culture and scraping showed no organisms. Immunofluorescence stain was positive for the herpes simplex virus antigen. The patient was started on oral valacyclovir, and progress was monitored through serial clinical photographs and anterior segment optical coherence tomography. Resolution began within 3 days of initiating treatment and was complete in 4 weeks. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.