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Porcine Corneal Tissue Explant to Study the Efficacy of Herpes Simplex Virus-1 Antivirals
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Published on: September 20, 2021

Herpes simplex keratitis after intravitreal triamcinolone acetonide.

Roni M Shtein1, Roslyn M Stahl, Stephen J Saxe

  • 1Department of Ophthalmology and Visual Sciences, University of Michigan, W.K. Kellogg Eye Center, Ann Arbor, MI, USA.

Cornea
|May 26, 2007
PubMed
Summary

Intravitreal triamcinolone acetonide injections for diabetic macular edema may trigger herpes simplex virus (HSV) keratitis recurrence. Prompt treatment with oral acyclovir resolved the ocular inflammation.

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Area of Science:

  • Ophthalmology
  • Virology
  • Pharmacology

Background:

  • Diabetic macular edema is a common complication of diabetes mellitus.
  • Intravitreal corticosteroid injections, such as triamcinolone acetonide, are used to treat diabetic macular edema.
  • Herpes simplex virus (HSV) keratitis is a recurrent infection of the cornea.

Observation:

  • A 59-year-old woman with a history of ocular HSV and proliferative diabetic retinopathy received an intravitreal triamcinolone acetonide injection.
  • One week post-injection, she presented with symptoms of foreign body sensation, redness, and photophobia.
  • Slit-lamp examination revealed a characteristic corneal epithelial dendritic lesion.

Findings:

  • The patient was diagnosed with a recurrence of herpes simplex virus epithelial keratitis.
  • Treatment with oral acyclovir (400 mg, 5 times daily) led to a good resolution of HSV signs and symptoms.
  • This case highlights a potential complication of intravitreal corticosteroid therapy.

Implications:

  • Intravitreal triamcinolone acetonide may precipitate herpes simplex virus keratitis reactivation in susceptible individuals.
  • Ophthalmologists should consider the risk of HSV recurrence when administering intravitreal corticosteroids to patients with a history of ocular HSV.
  • Early diagnosis and antiviral treatment are crucial for managing recurrent HSV keratitis.