Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series

Wang, Lixiang; Deng, Yingping; Ma, Keping; Yin, Hongbo; Sun, Chengshu; Tang, Jing

doi:10.2147/idr.s389920

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…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 ].…”

Section: Recurrent Herpes Simplex Keratitis: Clinical Features and Pr...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

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Section: Recurrent Herpes Simplex Keratitis: Clinical Features and Pr...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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Incidence and Outcomes of Infectious Keratitis After Corneal Collagen Cross-Linking Over 10 years From a Tertiary Care Center in South India

Lakshmipathy,

Deepak,

Agarwal

et al. 2024

Cornea

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Purpose: The purpose of this study was to report the incidence and outcomes of infectious keratitis after corneal collagen cross-linking (CXL) over 10 years in South India. Methods: Patients who underwent CXL for progressive keratoconus between January 2011 and December 2020 and those with infectious keratitis were identified from an electronic database system. The clinical and microbiological profiles of those affected were extracted from the case files and included in the analysis, whereas viral keratitis was excluded. Results: Eleven eyes with post-CXL infectious keratitis were identified, with 3842 CXL procedures (0.21%) occurring in-house, while 3 were referred from outside. The mean age of the patients was 21.8 ± 7.8 years, and 7 (64%) were male. Six eyes (54%) had conventional isotonic CXL, whereas 5 had hypotonic CXL when pachymetry was <400 μm. Six eyes (54%) presented with hypopyon at a median of 3 days after CXL. Culture of the corneal scrapings grew methicillin-sensitive Staphylococcus aureus in 4 patients, methicillin-sensitive Staphylococcus epidermidis in 2, Aspergillus fumigatus in 1, Aspergillus flavus in 1, Haemophilus parainfluenzae in 1, and no organisms in 2 patients. Almost all the isolates were resistant to ciprofloxacin and other fluoroquinolones. The majority of eyes responded well to intensive topical antibiotics guided by antibiograms and regained 6/18 vision (median). Therapeutic keratoplasty was needed in 2 eyes while cyanoacrylate glue was needed in another 2 eyes. Conclusions: Post-CXL infections are rare, most frequently caused by antibiotic-resistant commensals, and resemble the clinical spectrum and outcomes of non–CXL-related infectious keratitis in most cases.

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Herpes Simplex Keratitis Following Corneal Crosslinking for Keratoconus: A One-Year Case Series Follow-Up

Bagatin,

Radman,

Ranđelović

et al. 2024

Diagnostics

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Corneal crosslinking (CXL) is a medical procedure used to treat keratoconus. CXL works by strengthening the collagen fibers of the cornea through the application of riboflavin (vitamin B2) and ultraviolet (UV) light, which helps to stabilize the cornea and prevent further deterioration. There is a recognized risk that CXL can trigger the reactivation of dormant herpes simplex virus (HSV), leading to herpetic keratitis even in patients with no history of herpetic disease. We examined the medical history of 52 patients who underwent CXL procedures due to previously diagnosed keratoconus. We reviewed the patient’s medical histories to assess whether there was a herpes labialis infection and/or herpetic keratitis. Altogether, 52 eyes (from 52 patients) were analyzed. Of those, four (7.69%) patients were diagnosed with epithelial herpetic keratitis on the 5–8th day after surgery. All four patients had a history of herpes labialis and no prior HSV keratitis infection. Two patients developed herpetic keratitis despite prophylactic therapy with acyclovir 5 days before surgery. A positive history of HSV lip infection before CXL was present in 18/52 (34.62%). During a one-year follow-up period, no patient experienced a recurrence. Close follow-up is crucial for diagnosing herpetic keratitis after corneal crosslinking. The use of prophylactic antiviral therapy in patients who are asymptomatic and have a history of recurrent herpes labialis does not guarantee the prevention of infection.

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Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series

Cited by 3 publications

References 27 publications

Herpes simplex keratitis: A brief clinical overview

Herpes simplex keratitis: A brief clinical overview

Incidence and Outcomes of Infectious Keratitis After Corneal Collagen Cross-Linking Over 10 years From a Tertiary Care Center in South India

Herpes Simplex Keratitis Following Corneal Crosslinking for Keratoconus: A One-Year Case Series Follow-Up

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