Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy.
OBJECTIVE
The successful use of the Boston keratoprosthesis in a severely inflamed ulcer in herpes zoster neurotrophic keratopathy.


CONCLUSIONS
Approximately 10% to 20% of patients with herpes zoster will develop herpes zoster ophthalmicus (HZO). Antiviral medication forms the foundation of pharmacologic treatment for acute herpes zoster, but management of HZO is supplemented with topical and systemic antimicrobials and corticosteroid agents as well as surgical interventions. However, HZO is associated with poor healing, as evidenced by a high occurrence of ulceration, superinfection, and surgical failure.


METHODS
A 95-year-old man was referred for corneal edema in the right eye. There was a history of acute herpes zoster in the right eye 10 months previously. Slit-lamp examination revealed lagophthalmos, ectropion, total corneal anesthesia, and marked inferior corneal edema. Despite surgical repair of all lid abnormalities and aggressive lubrication and management of rosacea blepharitis, the corneal surface remained unhealthy. Four months later, the patient presented with an inflamed hypopyon ulcer, culture positive for abundant Pseudomonas and Candida albicans. The ulcer progressed to descemetocele in the face of aggressive antimicrobial therapy, vision was light perception (LP), and perforation became imminent. A Boston keratoprosthesis was used to replace the severely damaged cornea, and extracapsular cataract extraction of a mature cataract was also performed.


RESULTS
One week after surgery, the inflammation was almost entirely resolved, and cultures of the host button were negative for any organisms. Vision gradually increased from LP to 20/60 over the ensuing 4 months.


CONCLUSIONS
The Boston keratoprosthesis procedure successfully salvaged and restored vision in this high-risk herpes zoster eye in which standard keratoplasty would almost certainly have failed.
Pavan-Langston
Deborah
D
Massachusetts Eye And Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. deborah.langston@schepens.harvard.edu
Dohlman
Claes H
CH
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001187:Artificial Organs; D002177:Candidiasis / Q000382:microbiology / Q000601:surgery*; D002387:Cataract Extraction; D003315:Cornea; D003320:Corneal Ulcer / Q000382:microbiology / Q000601:surgery* / Q000821:virology; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000601:surgery*; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation; D011552:Pseudomonas Infections / Q000382:microbiology / Q000601:surgery*
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents