valacyclovir and Myopia

A 25-year-old woman presented with redness, pain, and diminution of vision that occurred 2 weeks after microkeratome-assisted laser in situ keratomileusis (LASIK). On presentation, corneal edema, Descemet membrane folds, keratic precipitates, stromal infiltrates, and flap necrosis were observed. Delayed post-LASIK microbial keratitis was diagnosed. The patient had no history of ocular herpes. Culture and scraping showed no organisms. Immunofluorescence stain was positive for the herpes simplex virus antigen. The patient was started on oral valacyclovir, and progress was monitored through serial clinical photographs and anterior segment optical coherence tomography. Resolution began within 3 days of initiating treatment and was complete in 4 weeks.

Topics: Acyclovir; Administration, Oral; Adult; Antigens, Viral; Antiviral Agents; Corneal Stroma; Female; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Myopia; Necrosis; Postoperative Complications; Simplexvirus; Surgical Flaps; Tomography, Optical Coherence; Uveitis, Anterior; Valacyclovir; Valine

To describe a 40-year-old woman who complained of visual loss in her left eye 3 days after an uneventful bilateral myopic refractive surgery by small incision lenticule extraction (SMILE).. Case report.. A 4 × 5 mm anterior central stromal infiltration was observed with moderate pain associated with decreased corneal sensitivity and neither discharge nor fluorescein staining. Bacterial and fungal smears and cultures from the SMILE interface were negative and local antibiotic ineffective. She was subsequently treated with peribulbar dexamethasone injections and oral valacyclovir. Corneal infiltration disappeared progressively, replaced by fibrotic stromal scarring. Optical coherence tomography displayed stromal hyperreflectivity mostly located above the lenticule cut with slight involvement of posterior stroma. In vivo confocal microscopy demonstrated activated keratocytes and highlighted the lack of subbasal corneal nerves in her left eye contrasting with her right eye.. Stromal herpetic keratitis could be considered a potential differential diagnosis to this atypical lamellar keratitis after a SMILE procedure. [J Refract Surg. 2016;32(12):855-857.].

Topics: Acyclovir; Adult; Antiviral Agents; Corneal Stroma; Corneal Surgery, Laser; Dexamethasone; Drug Therapy, Combination; Female; Fluorophotometry; Glucocorticoids; Humans; Keratitis; Microscopy, Confocal; Myopia; Tomography, Optical Coherence; Valacyclovir; Valine

To report the outcome of LASIK in patients with inactive herpetic keratitis in which perioperative antiviral prophylaxis was used to prevent the recurrence of ocular herpes.. We report an uncontrolled series of five patients with inactive herpetic keratitis for at least 1 year before surgery in whom LASIK was successfully performed. All patients showed normal topography, pachymetry, and corneal sensitivity with no central corneal scarring. Perioperative prophylaxis was used in each case with oral valacyclovir and topical acyclovir ointment.. None of the eyes developed reactivation of herpetic keratitis during follow-up.. This study suggests that perioperative antiviral prophylaxis may protect the cornea from herpes simplex virus reactivation after LASIK.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Male; Myopia; Ointments; Perioperative Care; Prodrugs; Treatment Outcome; Valacyclovir; Valine