[Descemetocele after Excimer laser phototherapeutic keratectomy in herpes simplex virus-induced keratitis: a clinico-pathologic correlation].

BACKGROUND

The indications for phototherapeutic keratectomy in superficial and deep corneal scars in Herpes simplex virus infections are controversial. Serious incidents after PTK have as yet not been reported.

PATIENTS AND

METHODS

A 62-year-old patient had suffered from recurrent central herpetic keratitis since 1948 and was treated for corneal scarring for the first time in 1992 by PTK. In 1995, epithelial defects were noted and, since medical treatment was unsuccessful, repeat PTK was performed. Two weeks after the second PTK, stromal infiltration with a subsequent corneal ulcer was followed by a descemetocele and perforation.

RESULTS

The recurrence of Herpes simplex keratitis was treated with systemic acyclovir, and the corneal perforation, the posterior synechiae and the complicated cataract were managed by a triple procedure à chaud (7.0 x 7.5 mm). The inflammation calmed down, and a significant improvement of vision was noted at dismissal. Histopathology of the corneal button showed no epithelial cells, endothelial cell rarefication, loss of Bowman's layer resulting from PTK, stromal edema, a descemetocele with perforation of 1.5 mm in diameter, and immunohistochemically Herpes simplex virus in the deep stroma and pre-Descemet.

CONCLUSIONS

Considering the clinical data and the histopathology we conclude that repeat excimer laser phototherapeutic keratectomy of herpetic keratitis without antiviral coverage may result in complications.