Posters

Recurrent endothelitis with intraocular hypertension

Poster Details

First Author: P.Puy SPAIN

Co Author(s):                        

Abstract Details

Purpose:

We describe a case of a patient with uniltaral recurrent endothelitis with sectorial corneal edema and intraocular hypertension, and his response to antiviral treatment at his first presentation. Next events were treated only with corticosteroids and hypotensive eye drops with complete resolution of every episode in a few days. The purpose of this presentation is to remark the importance of not overtreating patients with antivirals in cases of unilateral hypertensive uveitis or endothelitis.

Setting:

This patient has always been treated at the University Hospital of Fuenlabrada in Madrid, in the Ophthalmology department. His first visit was through emergency, but the cornea and uveitis unit has been in charge of the follow up.

Methods:

A complete anamnesis and ocular exploration (VA, BMC, IOP, fundus) were made in his first episode. In every visit VA, BMC and IOP were evaluated. Anterior segment pictures were used as a follow up to control the evolution. The first episode was treated with oral Valaciclovir 500 mgr twice a day, corticosteroids and ocular hypotensive eye drops. Two more episodes of sectorial corneal edema with intraocular hypertension are described with quick resolution being only treated with corticosteroids and ocular hypotensive eye drops. Pictures of the sectorial corneal edema, endothelial precipitates and its resolution are shown.

Results:

We describe a 57 year old patient who first complained of blurred vision. He has diabetes, hypertension, liver transplant due to VHC, and great myopia. The most remarkable sign was an inferior sectorial corneal edema with retrokeratic precipitates, iridian sphincter atrophy and IOP of 33 mmHg. He was diagnosed of probable herpetic endothelitis. In one week his intraocular pressure was 10 mmHg with no hypotensive eye drops, but he was kept on corticosteroids eye drops and oral Valaciclovir for one month. The next two episodes were treated without antivirals and a quick resolution was also found.

Conclusions:

Recurrent unilateral endothelitis or uveitis with intraocular hypertension are frequently diagnosed as herpetic and treated with antivirals that in some cases are maintained for several months. Scientific evidence shows that many of theses recurrent unilateral cases are viral. The diagnosis of viral endothelitis/uveitis should be by PCR but a lot of cases are treated without a microbiologic confirmation because of practical day a day clinic reasons. I conclude that recurrent unilateral hypertensive endothelitis/uveitis can be treated with corticosteroids and depending on the evolution decide if antivirals are needed, always excluding patients with queratouveitis at risk of developing epithelial lesions.

Financial Disclosure:

None