Herpes simplex reactivation following laser in situ keratomileusis and subsequent corneal perforation.
OBJECTIVE
To present a case of corneal perforation secondary to herpes simplex reactivation after laser in situ keratomileusis (LASIK) and its subsequent management. METHODSL A case report of a 69-year-old man who underwent LASIK after penetrating keratoplasty for herpes simplex keratitis (HSK) is presented.


RESULTS
The patient is a 69-year-old man who had a penetrating keratoplasty of the right eye 6 years prior for corneal scarring secondary to HSK. A spectacle refraction of -13.25 + 6.00 x 45 yielded 20/60 visual acuity in his grafted eye. LASIK was performed, and the patient's visual acuity without correction on postoperative day 1 was 20/60. Ten days after LASIK, the patient developed thinning of the cornea at the temporal edge of the flap, which perforated the following day. The perforation site was glued with cyanoacrylate adhesive and covered with a soft contact lens. After 7 months, a 4-mm lamellar keratoplasty and conjunctivoplasty was performed. Nine months after surgery, the patient's visual acuity without correction is 20/50 and the graft remains intact.


CONCLUSIONS
Herpes simplex keratitis may be a contraindication for LASIK in postkeratoplasty patients. Bandage contact lenses and cyanoacrylate adhesive can be used successfully to manage the rare complication of corneal perforation after LASIK.
Perry
Henry D
HD
Department of Ophthalmology, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, New York, USA. hankcornea@aol.com
Doshi
Sima J
SJ
Donnenfeld
Eric D
ED
Levinson
David H
DH
Cameron
C Douglas
CD
D000368:Aged; D003228:Conjunctiva / Q000601:surgery; D003263:Contact Lenses, Hydrophilic; D003315:Cornea / Q000601:surgery; D065306:Corneal Injuries; D016039:Corneal Transplantation; D003487:Cyanoacrylates / Q000627:therapeutic use; D006801:Humans; D016849:Keratitis, Herpetic / Q000150:complications*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D015948:Keratoplasty, Penetrating; D008297:Male; D008499:Medical Records; D011184:Postoperative Period; D012086:Reoperation; D018139:Simplexvirus / Q000502:physiology*; D014014:Tissue Adhesives / Q000627:therapeutic use; D014775:Virus Activation; D014792:Visual Acuity; D014950:Wounds, Penetrating / Q000188:drug therapy / Q000601:surgery / Q000821:virology*
D003487:Cyanoacrylates; D014014:Tissue Adhesives