Ramirez-Miranda Arturo, Mangwani-Mordani Simran, Quiroz-Casian Natalia, Oliva-Bienzobas Valeria, Cabral-Macias Jesus, Navas Alejandro, Graue-Hernandez Enrique O
Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico.
Case Rep Ophthalmol. 2021 Apr 12;12(1):227-231. doi: 10.1159/000511374. eCollection 2021 Jan-Apr.
A 28-year-old male presented unilateral visual loss, intense ocular pain, redness and intraocular hypertension in his right eye 2 days after undergoing small-incision lenticule extraction (SMILE) in both eyes. Initial examination of the affected eye revealed the presence of white infiltrates within the corneal interface, as well as a central epithelial defect. The patient was diagnosed with infectious keratitis, posteriorly the eye was irrigated with balanced saline solution and treatment was initiated with hourly moxifloxacin 0.5%. Since this approach failed to resolve symptoms, a sample from the interface was obtained for PCR assay, which revealed the presence of herpes simplex virus DNA, confirming the cause of the infection. The patient was prescribed a regimen of oral acyclovir, topical ganciclovir and prednisolone. Clinical improvement following resolution of the epithelial defect was observed. Although rare, herpetic keratitis following SMILE is best managed via early diagnosis and initiation of appropriate anti-herpetic treatment.
一名28岁男性在双眼行小切口基质透镜切除术(SMILE)后2天,右眼出现单侧视力丧失、剧烈眼痛、眼红和眼压升高。对患眼的初步检查发现角膜界面有白色浸润,以及中央上皮缺损。该患者被诊断为感染性角膜炎,随后用平衡盐溶液冲洗眼睛,并开始每小时使用0.5%的莫西沙星进行治疗。由于这种方法未能缓解症状,从界面取了样本进行聚合酶链反应(PCR)检测,结果显示存在单纯疱疹病毒DNA,证实了感染原因。给患者开了口服阿昔洛韦、局部用更昔洛韦和泼尼松龙的治疗方案。上皮缺损愈合后观察到临床症状改善。虽然罕见,但SMILE术后的疱疹性角膜炎最好通过早期诊断和开始适当的抗疱疹治疗来处理。