Combined Bacterial and Herpes Simplex Virus Keratitis following Small-Incision Lenticule Extraction for the Correction of Myopia

• Published in: Case reports in ophthalmology Vol. 12; no. 1; pp. 227 - 231
• Main Authors: Ramirez-Miranda, Arturo, Mangwani-Mordani, Simran, Quiroz-Casian, Natalia, Oliva-Bienzobas, Valeria, Cabral-Macias, Jesus, Navas, Alejandro, Graue-Hernandez, Enrique O.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-01-2021; Karger Publishers
• Subjects: Antibiotics; Antiviral drugs; Case Report; Case reports; Cornea; herpes simplex virus; Herpes viruses; keratitis; Lasers; Patient satisfaction; small-incision lenticule extraction; Streptococcus infections; Surgeons; Surgery; Small-incision lenticule extraction; Herpes simplex virus; Keratitis
• ISSN: 1663-2699; 1663-2699
• DOI: 10.1159/000511374

A 28-year-old male presented unilateral visual loss, intense ocular pain, redness and intraocular hypertension in his right eye 2 days after undergoing small-incision lenticule extraction (SMILE) in both eyes. Initial examination of the affected eye revealed the presence of white infiltrates within the corneal interface, as well as a central epithelial defect. The patient was diagnosed with infectious keratitis, posteriorly the eye was irrigated with balanced saline solution and treatment was initiated with hourly moxifloxacin 0.5%. Since this approach failed to resolve symptoms, a sample from the interface was obtained for PCR assay, which revealed the presence of herpes simplex virus DNA, confirming the cause of the infection. The patient was prescribed a regimen of oral acyclovir, topical ganciclovir and prednisolone. Clinical improvement following resolution of the epithelial defect was observed. Although rare, herpetic keratitis following SMILE is best managed via early diagnosis and initiation of appropriate anti-herpetic treatment.