Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series

Abstract

Background: 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.

Herpes simplex keratitis: A brief clinical overview

“…Researchers have reported cases of HSV relapse with ocular presentations after Botulinum Toxin injection[ 231 - 233 ]. Recurrence of HSK dendritic epithelial keratitis should be considered for following CXL in keratoconus patients with suspicious history[ 234 , 235 ]. It has been postulated that the ultraviolet radiation A light, damage to the epithelial/stroma trauma, or damage to the nerves of the cornea during the cornea cross-linking could result in recurrent HSV[ 236 , 237 ].…”