BACKGROUND
Keratitis caused by herpes simplex virus (HSV) can have detrimental effects on the cornea leading to loss of vision. Modern
therapies can contribute to the prevention of anatomical and functional damage. CASE REPORT An 80-year-old male with complicated HSV-1
keratitis of the left eye (confirmed diagnosis after microbiological investigation) presented three months after
antiviral treatment with corneal blurring, severe epitheliopathy, thinning of the stroma, and neovascularization. At the time he was referred, the visual acuity of his left eye was very low, as he could only count fingers at a one-foot distance. He was initially started on oral
acyclovir (800 mg once daily) and topical poly-carboxymethyl
glucose sulfate; afterwards he underwent amniotic membrane (AM)
transplantation and localized treatment with anti-
VEGF factors. One month after the AM
transplantation there was an obvious improvement of the corneal surface. Ophthalmic
suspension of
cyclosporine-A 1% was also added to his treatment. After three months, a
transplantation of stem cells (deriving from the sclerocorneal junction of his right eye) was carried out at the sclerocorneal junction, as the
corneal damage and neovascularization was more severe at this anatomical area. Four months after the last surgery, his visual acuity was 1/10 (note, he had a history of an old vascular episode) and the cornea was sufficiently clear with no signs of epitheliopathy and almost complete subsidence of the neovascularization. CONCLUSIONS
Transplantation of AM and stem cells in combination with anti-
VEGF factors and
topical administration of
cyclosporine-A 1% and poly-carboxymethyl
glucose sulfate (a regenerative factor of corneal matrix) contributed substantially in the management of
herpetic keratitis complications.