Cases reported "Keratitis, Herpetic"

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11/74. Polymicrobial keratitis after laser in situ keratomileusis.

    PURPOSE: To report a case of polymicrobial infectious keratitis in one eye of a patient who had undergone bilateral simultaneous laser in situ keratomileusis (LASIK). methods: A 21-year-old healthy female developed infectious keratitis in her right eye after bilateral LASIK surgery. Material obtained from the infective foci was sent for bacterial and fungal cultures and herpes simplex virus antigen detection, and broad spectrum antimicrobial therapy was instituted. RESULTS: staphylococcus epidermidis and fusarium solani were detected on culture and herpes simplex virus antigen was found to be positive. The patient did not respond to medical therapy and subsequently the ulcer perforated. A therapeutic keratoplasty was performed and the final best-corrected visual acuity was 20/40, 1 month after keratoplasty. CONCLUSION: Polymicrobial infectious keratitis, although rare, is a potential sight-threatening complication of LASIK. ( info)

12/74. Atypical herpes simplex keratitis (HSK) presenting as a perforated corneal ulcer with a large infiltrate in a contact lens wearer: multinucleated giant cells in the Giemsa smear offered a clue to the diagnosis.

    PURPOSE: To report a case of atypical herpes simplex keratitis initially diagnosed as bacterial keratitis, in a contact lens wearer. RESULTS: Case report of an 18-year-old woman using contact lenses who presented with pain, redness and gradual decrease in vision in the right eye. Examination revealed a paracentral large stromal infiltrate with a central 2-mm perforation. Corneal and conjunctival scrapings were collected for microbiological investigations. Corneal tissue was obtained following penetrating keratoplasty. Corneal scraping revealed no microorganisms. Giemsa stained smear showed multinucleated giant cells. Conjunctival, corneal scrapings and tissue were positive for herpes simplex virus - 1 (HSV) antigen. Corneal tissue was positive for HSV dna by PCR. CONCLUSIONS: Atypical HSV keratitis can occur in contact lens wearers. A simple investigation like Giemsa stain may offer a clue to the diagnosis. ( info)

13/74. Healing of recurrent herpes simplex corneal epithelial lesions treated with topical acyclovir A non-contact photomicrographic in vivo study in the human cornea.

    PURPOSE: To examine morphological changes occurring in recurrent herpes simplex virus (HSV) epithelial keratitis after the application of topical acyclovir ointment 3%. MATERIAL AND methods: 7 patients examined with the slit lamp and photographed by non-contact in vivo photomicrography. RESULTS: Within one day of treatment the lesions lost their typical herpetic features, and after about 2-3 days the morphology seemed to reflect only the sequelae: unhealthy epithelium and abnormal cells located at the level of the basement membrane. Two patients showed epitheliopathy compatible with the side-effects of the treatment. CONCLUSIONS: The rapid loss of typical HSV features after drug application reflects a successful arrest of the virus replication, freeing the epithelial healing forces. At what point of time infectious virus is eradicated and the treatment can be safely stopped cannot be determined clinically. Healing in the sense of restitution ad integrum is a slow process showing individual variations. Abnormal intra-/subepithelial cells are last to disappear. ( info)

14/74. herpes simplex virus bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma: an unusual presentation.

    PURPOSE: To report an unusual case of herpetic bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma. RESULTS: A retrospective analysis of the case record of a 60-year-old man who had earlier undergone bilateral cataract surgery, was done. He presented with a complaint of decrease in vision in the right eye of 20 days duration. On examination, cornea showed epithelial bullae all over the surface with stromal and epithelial edema. intraocular pressure was 30 mm of Hg in RE. He was treated with anti-glaucoma medications. Two dendritic lesions were seen in the cornea during a subsequent visit four days later. Virological investigations confirmed a diagnosis of herpes simplex keratitis. He was treated with topical acyclovir. CONCLUSIONS: This case highlights the fact that herpes simplex keratitis can present initially as a more diffuse corneal stromal and epithelial edema with epithelial bullae mimicking bullous keratopathy. Herpetic bullous keratitis, although unusual, should be considered in the differential diagnosis under such circumstances. ( info)

15/74. Retrocorneal membrane with Descemet's detachment.

    PURPOSE: To describe a unique case of retrocorneal membrane with large Descemet's detachment. methods: Case report of a 65-year-old man reported intermittent cloudy vision in his left eye. The patient underwent serial ocular examinations and slit-lamp photography over 6 weeks. RESULTS: The patient had an inflammatory-appearing membrane that covered 60% of the posterior cornea, with a subtotal Descemet's detachment. Vision was stable at 20/20, and the cornea remained clear. The patient was empirically treated with topical neomycin/polymyxin/dexamethasone, sodium chloride, and oral acyclovir, and his symptoms improved; however, the retrocorneal membrane persisted. CONCLUSION: This unusual clinical finding may represent reduplicated Descemet's membrane with partial Descemet's detachment secondary to occult deep herpes simplex keratitis. Other possibilities include spontaneous or traumatic Descemet's tear and detachment. ( info)

16/74. Stromal keratitis and anterior uveitis due to herpes simplex virus-2 in a young child.

    BACKGROUND: An uncommon case of stromal keratitis and anterior uveitis due to herpes simplex virus type 2 (HSV-2) is reported. CASE: The patient was a 3-year-old boy admitted for conjunctival injection of the right eye of unknown cause, accompanied by corneal opacity and anterior uveitis. OBSERVATIONS: High titers of antibodies against HSV and Epstein-Barr virus (EBV) were found in blood samples. polymerase chain reaction (PCR) for the detection of HSV-1, -2, and EBV genome fragments was carried out using an anterior chamber sample as a template. An HSV-2 genome fragment was amplified by PCR. Administration of acyclovir and betamethasone was started, with the consequent elimination of corneal opacity, inflammatory cells, and keratic precipitates. CONCLUSION: PCR clearly showed that HSV-2 was the causative pathogen of the stromal keratitis and anterior uveitis in this young patient. Systemic EVB infection may induce systemic immunocompromised conditions that can lead to reactivation of HSV-2 followed by ocular disorders. ( info)

17/74. Reactivation of herpes simplex virus keratitis after initiating bimatoprost treatment for glaucoma.

    PURPOSE: To report a case of herpes simplex virus reactivation after starting bimatoprost treatment for glaucoma. DESIGN: Interventional case report. methods: A 66-year-old woman had a herpes simplex keratouveitis reactivation that occurred within 1 month after starting bimatoprost. The herpes simplex had been inactive for more than 10 years. RESULTS: Bimatoprost and prednisolone acetate 0.12% were discontinued; oral acyclovir, ofloxacin, and betaxolol 0.25% were initiated. Two weeks later, prednisolone acetate 1% was added. The reactivation resolved, and 1 month later, the best corrected visual acuity improved to 20/40. CONCLUSION: Caution should be used in prescribing bimatoprost for patients with a history of herpes simplex virus keratitis. ( info)

18/74. Persisting epithelial herpes simplex keratitis while on cyclosporin-A ointment.

    BACKGROUND: This is the first report of cyclosporin-A ointment (CsA) adversely affecting epithelial herpes simplex virus keratitis in a corneal graft. methods: The details of this case were obtained from the patient's record at The Wilmer Ophthalmological Institute. RESULTS: Ceasing CsA ointment resulted in resolution of the epithelial HSV keratitis. CONCLUSION: immunosuppression caused by CsA ointment resulted in persisting epithelial HSV keratitis despite adequate topical treatment. ( info)

19/74. Corneal endotheliitis and idiopathic sudden sensorineural hearing loss.

    PURPOSE: To report a case with corneal endotheliitis and idiopathic sudden sensorineural hearing loss, in which herpes simplex virus type 1 dna was demonstrated in the trabeculum and the aqueous humor by polymerase chain reaction. DESIGN: Interventional case report. methods: A 60-year-old man presented with corneal stromal edema in the right eye and sudden bilateral sensorineural hearing loss. The trabeculum excised during trabeculectomy and the aqueous humor were examined for the presence of herpes simplex virus type 1 dna by polymerase chain reaction. RESULTS: polymerase chain reaction demonstrated herpes simplex virus type 1 dna in the aqueous humor and the trabeculum. CONCLUSION: herpes simplex virus type 1 may cause corneal endotheliitis and idiopathic sudden sensorineural hearing loss simultaneously. ( info)

20/74. herpes simplex reactivation following laser in situ keratomileusis and subsequent corneal perforation.

    PURPOSE: To present a case of corneal perforation secondary to herpes simplex reactivation after laser in situ keratomileusis (LASIK) and its subsequent management. METHODSL A case report of a 69-year-old man who underwent LASIK after penetrating keratoplasty for herpes simplex keratitis (HSK) is presented. RESULTS: The patient is a 69-year-old man who had a penetrating keratoplasty of the right eye 6 years prior for corneal scarring secondary to HSK. A spectacle refraction of -13.25 6.00 x 45 yielded 20/60 visual acuity in his grafted eye. LASIK was performed, and the patient's visual acuity without correction on postoperative day 1 was 20/60. Ten days after LASIK, the patient developed thinning of the cornea at the temporal edge of the flap, which perforated the following day. The perforation site was glued with cyanoacrylate adhesive and covered with a soft contact lens. After 7 months, a 4-mm lamellar keratoplasty and conjunctivoplasty was performed. Nine months after surgery, the patient's visual acuity without correction is 20/50 and the graft remains intact. CONCLUSION: herpes simplex keratitis may be a contraindication for LASIK in postkeratoplasty patients. Bandage contact lenses and cyanoacrylate adhesive can be used successfully to manage the rare complication of corneal perforation after LASIK. ( info)
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