Herpetic Keratitis After Descemet Stripping Automated Endothelial Keratoplasty for Failed Graft

Objectives: To report a case of herpetic epithelial keratitis after Descemet stripping automated endothelial keratoplasty (DSAEK) for a failed graft. Methods: A 31-year-old female patient underwent DSAEK for failed graft in left eye. She previously had undergone penetrating keratoplasty for keratoconus in that eye. Results: One week after DSAEK, the patient presented with pain in left eye. The cornea showed two epithelial defects with dendritic edges that involved the penetrating keratoplasty graft host junction and showed positive fluorescein staining. Diagnosis of herpes simplex virus keratitis was made and the patient was started on oral acyclovir and topical trifluiridine. The epithelial lesions showed complete resolution ill 3 days. Conclusions: Herpes simplex virus epithelial keratitis can occur after DSAEK for failed grafts even in the absence of previous history of herpes simplex virus infection and should be considered in the differential diagnosis of postoperative epithelial defects.