Sitaula Sanjeeta, Singh Sanjay K, Gurung Anil
B.P.Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Institute Of Medicine, Kathmandu, 44600, Nepal.
Department of Cornea Clinic, Biratnagar Eye Hospital, Biratnagar, Nepal.
J Ophthalmic Inflamm Infect. 2019 Aug 28;9(1):16. doi: 10.1186/s12348-019-0185-8.
Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus.
An 18-year-old boy underwent corneal collagen crosslinking in both the eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in 5 days. Seven days later, the patient returned with severe pain, redness, and photophobia for the last 2 days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both the eyes and the corneal sensation was reduced. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment, and the cornea had a faint scar at 1 month follow-up with best-corrected visual acuity of 6/9 in both eyes with a rigid gas permeable lens.
Ultraviolet A light could be a stimulus to trigger reactivation of latent HSV infections even in patients with no history of clinically evident herpes virus ocular infections. Early diagnosis and timely treatment can have good visual outcome. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.
角膜胶原交联已被证明是一种减缓圆锥角膜进展的有用技术。随着其使用的增加，我们遇到了罕见的并发症。我们描述了一例在使用核黄素和紫外线A进行角膜胶原交联治疗进展性圆锥角膜后发生双侧病毒性角膜炎的病例。
一名18岁男孩因双侧进展性圆锥角膜在同一次手术中对双眼进行了角膜胶原交联。他出院时佩戴软性绷带接触镜，并被要求在5天后复诊。7天后，患者因过去2天出现的严重疼痛、眼红和畏光症状复诊。绷带接触镜被取下。双眼角膜中央有树枝状分支病变，角膜感觉减退。根据这些发现，临床诊断为双侧病毒性角膜炎。经口服和局部使用阿昔洛韦治疗，树枝状病变在10天内完全愈合，1个月随访时角膜有轻微瘢痕，佩戴硬性透气性接触镜时双眼最佳矫正视力为6/9。
即使在无临床明显疱疹病毒眼部感染病史的患者中，紫外线A光也可能是触发潜伏性单纯疱疹病毒感染重新激活的刺激因素。早期诊断和及时治疗可取得良好的视力预后。对于有病毒性角膜炎既往史的个体，预防性抗病毒药物可能有助于预防这种并发症。
