Posters

Necrotic herpetic keratitis manifested by descemetocele: a case report

Poster Details

First Author: M.Bouggar MOROCCO

Co Author(s): N. Laaribi   T. Abdellaoui   F. El Asri   K. Reda   A. Oubaaz        

Abstract Details

Purpose:

We report the case of a necrotic herpetic keratitis with a rare manifestation which is descemetocele; who presented to ophtalmic emergencies with painful red eye and drop of visual acuity. The evolution was marked by a progressive anatomic healing of the cornea under antiviral, as shown by anterior segment tomography (AS-OCT) based control, promoted by the use of tarsorraphy.

Setting:

Mohammed V military instruction hospital ; Rabat, MOROCCO

Methods:

Photographs and anterior segment tomography (AS-OCT) before treatment and during the follow up. 69-year-old patient, who came to ophtalmic emergencies for a right painful red eye with decreased visual acuity. Examination finds visual acuity limited to 1/20, a hyperemic conjunctiva with purulent secretions. The cornea was hypoesthesic with a large  ulceration centred with a descemetocele the all surrounded by stromal edema. Treatment with topical antibiotic and antiviral intravenously, was initiated after corneal sampling was done; also, the patient had a tarsorraphy. DNA research of herpes simplex virus type 1 by PCR was positive confirming the diagnosis of necrotic herpetic keratitis.

Results:

There was a rapid cleaning of the conjunctiva and a very slow healing of the ulcer and the corneal perforation. The patient benefited from tarsorraphy promoting healing -which was controlled by corneal oct- and also a switch to oral antivirals. In the AS-OCT examination, the anatomic healing of the cornea under antiviral was evidenced. The visual acuity at the end of the period of hospitalization was of 3/10.

Conclusions:

Corneal ulceration leading to descemetocele formation can result from infectious conditions amongst other causes; the therapeutic management must be urgent and effective to allow an appropriate anatomic healing of the cornea promoted by the use of tarsorraphy.

Financial Disclosure:

None