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Case Reports
. 2023 Feb 20;13(1):93-96.
doi: 10.4103/tjo.TJO-D-22-00156. eCollection 2023 Jan-Mar.

Herpes endotheliitis following laser-assisted in situ keratomileusis and photorefractive keratectomy

Majid Moshirfar  1   2   3 , Melody Ziari  4 , Christian Peterson  5 , Neil Kelkar  6 , Yasmyne Ronquillo  1 , Phillip Hoopes  1
Affiliations
Case Reports

Herpes endotheliitis following laser-assisted in situ keratomileusis and photorefractive keratectomy

Majid Moshirfar et al. Taiwan J Ophthalmol. .

Abstract

Herpes endotheliitis is a less common manifestation of herpes keratitis, and characteristic examination findings include corneal edema and the presence of keratic precipitates. Infection may be primary or secondary to herpes virus reactivation following exposure to a potential trigger such as physiologic stress or environmental factors. Ocular surgery, including laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), can trigger reactivation in patients with or without a documented history of previous herpes infection. We present two patients with visually insignificant stromal scarring who denied a previous history of herpetic disease and developed herpes endotheliitis following LASIK and PRK. We demonstrate the importance of an appropriately thorough preoperative evaluation and further workup of any corneal abnormalities, even if such findings initially appear inconsequential.

Keywords: Cornea; cytomegalovirus; herpes endotheliitis; herpes keratitis; herpes simplex virus; refractive surgery.

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Conflict of interest statement

The authors declare that there are no conflicts of interest in this article.

Figures

Figure 1
Figure 1
(a) Corneal hyperlucency on Anterior Segment Optical Coherence Tomography (AS-OCT) (white arrows). (b and c) Topographic distortion (white circle and gray dashed circle) corresponding to the location of the preoperative corneal pannus, stromal scar, and neovascularization
Figure 2
Figure 2
(a) Discrete region of edema consistent with disciform keratitis (white arrows) and previous laceration (black arrow). (b) Beaten bronze appearance of the endothelium (white arrows)
Figure 3
Figure 3
(a) Opacification of the cornea on Anterior Segment Optical Coherence Tomography (AS-OCT) (white arrow). (b and c) Distortion on corneal topography (white circle and gray dashed circle) in the area of the paracentral stromal scar
Figure 4
Figure 4
(a) Beaten bronze appearance of endothelial (white arrow) and KPs (black arrow). (b) Specular microscopy showing the inability to assess endothelial integrity in the right eye compared to the normal endothelium in the left eye, KPs: Keratic precipitates
See this image and copyright information in PMC

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