Extreme Case of Simultaneous Phaco With Foldable IOL and DSEK in HSV Endotheliitis
It is now agreed that DSEK may be better option than PK, when corneal decompensation occurs after recurrent attack of HSV endothelitis. Doing simultaneous Phaco with Foldable IOL in aged patients is difficult because of very poor visibility. But coaxial stereo Illumination helps. Here is an extreme example.
One-eyed 60 years old-male-patient was referred for PK with IOL. He presented with BCVA of HM, and dense corneal edema with temporal vascularisation with poor anterior chamber view. He had history of recurrent attacks of herpes simplex keratitis. Under cover of oral acyclovir and oral corticosteroids, the surgery was performed. The plan was changed on OT table.
Phacoemulsification with IOL implantation was possible under stereo coaxial Illumination of operating microscope and then DSEK was performed. Oral acyclovir, steroids and topical ganciclovir continued. Cornea gradually cleared over a period of 6 months with BCVA of 20/60 without any recurrence of HSV keratitis.
Coaxial stereo Illumination of the operating microscope does help in extreme situation. Simultaneous oral Prednisolone and Acyclovir have equal role for better graft survival and possibly to prevent recurrence of HSV keratitis.