Activation ofCytomegaloviruscorneal endotheliitis following laser in situ keratomileusis

Abstract

A case of Cytomegalovirus (CMV) corneal endotheliitis following laser in-situ keratomileusis (LASIK) is presented. A 32-year-old man presented 3 weeks after uncomplicated myopic LASIK with unilateral LASIK flap oedema, interface fluid accumulation, keratic precipitates, anterior uveitis and raised intraocular pressure. Despite treatment with topical corticosteroids, he had 3 further recurrent episodes. Specular microscopy showed decreased endothelial cell density and aqueous humour. Polymerase chain reaction (PCR) testing was positive for CMV DNA. He was treated with topical ganciclovir and ketorolac, and the inflammation and oedema resolved. Repeat aqueous humour PCR testing was negative for CMV DNA, and he remained well at last follow-up (3 months after stopping all medications). CMV corneal endotheliitis can be reactivated after LASIK, and CMV DNA PCR of aqueous humour samples can help in definitive diagnosis. Early recognition and treatment of this condition is important to prevent permanent endothelial cell loss and corneal decompensation.

<p>Corneal Refractive Surgery in Patients with a History of Herpes Simplex Keratitis: A Narrative Review</p>

“…53 The patient had no known history of CMV and activation was believed to be due to local immunosuppression secondary to the steroids received, similar to cases seen after cataract surgery and corneal transplantation. 53,62,63 A similar case reported by Bacsal et al discussed a patient with anterior uveitis and increased IOP two months after LASIK. The patient was eventually diagnosed with CMV uveitis and treated with oral valganciclovir and topical rimexolone for 10 weeks.…”

“…52 However, only three case studies were found in the literature demonstrating reactivation of CMV and VZV after corneal refractive surgery. [53][54][55] The reactivation of VZV occurred two months after LASIK, with the patient making a full recovery after treatment with valacyclovir 500 mg twice daily and topical acyclovir twice daily. 54 In a separate case report, Kaufman et al reported a patient with a previous corneal scar due to herpes zoster ophthalmicus (HZO) who underwent PTK, PRK, and LASIK without reactivation.…”

Incidence and Risk Factors of New Onset Endotheliitis After Cataract Surgery

“…16 Previous reports observed that surgical trauma can cause infection in a case with no previous history of viral eye disease. 17,18 Tan et al 7 reported the occurrence of corneal endotheliitis 3 weeks following laser in situ keratomileusis. Viral endotheliitis or keratitis after cataract surgery has previously been described in the literature.…”

“…Surgical trauma can lead to infection in cases with no previous history of viral eye disease. [7][8][9][10][11][12] Endotheliitis following cataract surgery is a rare condition. 13 Herein, we examined a large cohort of patients who underwent cataract surgery and subsequently developed postoperative endotheliitis, providing insights into the incidence and potential risks factors of this disease.…”