HSV-1 in a case of intractable glaucoma with rapid progress of cataract after transscleral cyclophotocoagulation

Hui-Chuan Chung; I-Lun Tsai; Ching-Yao Tsai; Shiow-Wen Liou; Lin-Chung Woung

doi:10.1016/j.tjo.2011.09.002

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CASE REPORT

Year : 2011 \| Volume : 1 \| Issue : 1 \| Page : 25-27

HSV-1 in a case of intractable glaucoma with rapid progress of cataract after transscleral cyclophotocoagulation Hui-Chuan Chung¹, I-Lun Tsai¹, Ching-Yao Tsai², Shiow-Wen Liou³, Lin-Chung Woung⁴ ¹ Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan ² Department of Ophthalmology, Taipei City Hospital; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan ³ Department of Ophthalmology, Taipei City Hospital; Department of Ophthalmology, Taipei Medical University; Department of Ophthalmology, National University Hospital, Taipei, Taiwan ⁴ Department of Ophthalmology, Taipei City Hospital; Department of Ophthalmology, National University Hospital, Taipei, Taiwan Correspondence Address: I-Lun Tsai Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No. 145, Zhengzhou Road, Datong District, Taipei City 10341 Taiwan Source of Support: None, Conflict of Interest: None DOI: 10.1016/j.tjo.2011.09.002

A 22-year-old female patient received penetrating keratoplasty (PK) of her right eye for ocular rosacea complicated with corneal perforation. Intraocular pressure (IOP) fluctuated and could not be well controlled by full antiglaucomatous agents after surgery. Therefore transscleral diode laser cyclo-photocoagulation (TSCPC) was performed for the intractable glaucoma one year after PK. Unfortunately, acute cataract formation was noted 50 days after the laser treatment. Pigmented keratic precipitates (KPs) developed and IOP rose subsequently. Cataract extraction with intraocular lens implantation combined with trabeculectomy was performed 3 months later. Polymerase chain reaction (PCR) tests of the aqueous humor to detect cytomegalovirus (CMV) and herpes simplex virus (HSV) were negative. However, HSV type I DNA was detected in the lenticular material and excised trabecular tissue. Trabe-culitis caused by herpetic infection could be the reason of fluctuated and intractable IOP elevation. The virus hidden in the intraocular tissue could be reactivated by TSCPC and result in cataract formation. Therefore, performing TSCPC in a phakic eye with atypical IOP presentation should be undertaken with caution.



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