Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Abstract

Introduction Severe viral keratitis with hypopyon and retrocorneal plaques is easily misdiagnosed as it mimics fungal or bacterial keratitis and is more likely to undergo emergency therapeutic penetrating keratoplasty (TPK) in the presence of active infection, resulting in poor outcomes. This case series offers some important insights for the management strategy of severe viral keratitis. Methods This retrospective case series involved five patients with unilateral severe infectious keratitis with hypopyon over 3 mm and retrocorneal endothelial plaques. Testing for corneal sensation, microscopy, culture, and anterior segment optical coherence tomography (ASOCT) were performed. Results At presentation, all five cases had visual acuity of counting fingers (CF) or worse, large centrally located ulcer with clean ulcer surface, hypopyon, and retrocorneal plaques with reduced corneal sensation. ASOCT demonstrated the presence of retrocorneal plaques with clear space between corneal endothelium and plaques. All cases received systemic and topical ganciclovir and topical steroids. Two patients received intravenous immunoglobulin (IVIG) weekly for 2 weeks. Complete resolution was achieved in all cases except one patient who underwent TPK because of diffuse anterior synechiae of the iris, with recurrence of infection after 10 days. The patients who received IVIG showed resolution earlier compared to the other patients. Conclusions Evaluation of characteristics of retrocorneal plaques by ASOCT and reduced corneal sensation are valuable aids in diagnosis of complicated viral keratitis. Conservative medical management may be a viable option even in severe cases. IVIG may have a role in speedy resolution of severe cases, but more research is needed to confirm this. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00592-x.

Antimicrobial and Immunostimulatory Effects of Senna occidentalis Ethanolic Extract against Aspergillus flavus-Induced Mycotic Keratitis: A Promising Therapeutic Approach

“…extract did not have any adverse effects on liver functions in animal models used for treatment. Furthermore, Yang et al [74] validated the safety of Senna sp. extract on the various functions and tissues of the liver and kidney in albino mice while treating their dry eyes.…”

“…The study found that the extract promoted the regeneration of corneal tissues and did not negatively affect liver and kidney functions. Additionally, the extract enhanced the antifungal activity of macrophages, indicating an improved immune response against fungal eye infections [74]. Plant extracts, which are natural immunomodulators, enhance a compromised immune system and reduce an over-aggressive immunological response [78].…”