Endothelial keratoplasty detachment secondary to herpes simplex dendritic ulcer

Abstract

One month after the original procedure the patient returned with symptom of a sore left eye. On examination there was a localised detachment of the DMEK graft and interestingly in the exact area overlying this there was a dendritic ulcer, there were no signs of rejection with the rest of the graft remaining attached and clear (figures 1 and 2). There was no known ocular history of herpetic eye disease or any history of immunosuppression (asides from diet controlled type 2 diabetes mellitus). The occurrence of herpes simplex virus keratitis (HSVK) had resulted in localised graft detachment. Treatment for HSVK was started with aciclovir eye ointment five times per day and higher dose 1 g oral valaciclovir three times per day. The HSVK responded well so after 25 days the regime was reduced to a maintenance higher dose of oral valacivlovir 1 g once a day.