https://doi.org/10.4081/ltj.2024.397

Keratorefractive lenticule extraction in eyes with post-herpetic scars

Vol. 31 No. 1 (2024)
Submitted: 18 March 2024
Accepted: 2 June 2024
Published: 1 July 2024
Keratorefractive Lenticule Extraction (KLEx), myopia, herpes simplex virus, keratitis
Abstract Views: 773
PDF: 21
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Antonio Leccisotti
leccisotti@libero.it
https://orcid.org/0000-0001-9953-0535
Siena Eye Laser, Poggibonsi, Siena, Italy; School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom.
Stefania V. Fields
Siena Eye Laser, Poggibonsi, Siena, Italy.
Giuseppe De Bartolo
Siena Eye Laser, Poggibonsi, Siena, Italy.
Christian Crudale
https://orcid.org/0009-0006-4002-1481
Siena Eye Laser, Poggibonsi, Siena, Italy.
Matteo Posarelli
Siena Eye Laser, Poggibonsi, Siena, Italy; Liverpool University, United Kingdom.

Correcting refractive errors by remodeling the corneal curvature with an excimer laser (which emits ultraviolet radiation) may reactivate a latent Herpes Simplex Virus (HSV), resulting in keratitis. New techniques using infrared sources, such as femtosecond-assisted Keratorefractive Lenticule Extraction (KLEx), may thus provide a safer approach to eyes with previous HSV keratitis; however, no cases of KLEx in such cases have been reported. As a result, we present three cases in which KLEx successfully corrected myopia. Three myopic eyes from three patients with a known history of healed HSV keratitis that occurred more than 12 months before surgery underwent KLEx. All patients received oral antiviral prophylaxis before and after surgery. In case 1, the post-HSV scar was semiperipheral, involving only a portion of the treated area; surgery went smoothly, with the intrastromal lenticule well delineated and dissected even through the scar. In cases 2 and 3, the healed scar was peripheral and did not interfere with surgery. After 6 months, all three cases had good visual acuity without complications. Finally, KLEx combined with antiviral prophylaxis can effectively correct myopia in eyes with healed HSV. The femtosecond laser can penetrate non-dense, peripheral corneal scars.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Moshirfar M, Milner DC, Baker PA, et al. Corneal refractive surgery in patients with a history of herpes simplex keratitis: a narrative review. Clin Ophthalmol 2020;14:3891–3901 DOI: https://doi.org/10.2147/OPTH.S282070
Pepose JS, Laycock KA, Miller JK, et al. Reactivation of latent herpes simplex virus by excimer laser photokeratectomy. Am J Ophthalmol 1992;114:45–50. DOI: https://doi.org/10.1016/S0002-9394(14)77411-2
Asbell PA. Valacyclovir for the prevention of recurrent herpes simplex virus eye disease after excimer laser photokeratectomy. Trans Am Ophthalmol Soc. 2000;98:285-303.
Dupps WJJr, Randleman JB, Kohnen T, et al. Scientific nomenclature for keratorefractive lenticule extraction (KLEx) procedures: a joint editorial statement. J Cataract Refract Surg 2023;49:1085. DOI: https://doi.org/10.1097/j.jcrs.0000000000001328
Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol 2011;95:335–9. DOI: https://doi.org/10.1136/bjo.2009.174284
Ramirez-Miranda A, Mangwani-Mordani S, Quiroz-Casian N, et al. Combined bacterial and Herpes Simplex Virus keratitis following small-incision lenticule extraction for the correction of myopia. Case Rep Ophthalmol 2021;12:227–31. DOI: https://doi.org/10.1159/000511374
Leccisotti A, Fields SV, De Bartolo G. Refractive corneal lenticule extraction with the CLEAR femtosecond laser application. Cornea 2023;42:1247-56. DOI: https://doi.org/10.1097/ICO.0000000000003123
Dhaliwal DK, Barnhorst DA, Romanowski E, et al. Efficient reactivation of latent herpes simplex virus type 1 infection by excimer laser keratectomy in the experimental rabbit ocular model. Am J Ophthalmol 1998;125:488–92. DOI: https://doi.org/10.1016/S0002-9394(99)80189-5
Moshirfar M, Welling JD, Feiz V, et al. Infectious and noninfectious keratitis after laser in situ keratomileusis occurrence, management, and visual outcomes. J Cataract Refract Surg 2007;33:474–83. DOI: https://doi.org/10.1016/j.jcrs.2006.11.005
Davidorf JM. Herpes simplex keratitis after LASIK. J Refract Surg 1998;14:667. DOI: https://doi.org/10.3928/1081-597X-19981101-18
Kamburoglu G, Ertan A. Peripheral herpes simplex keratitis following LASIK. J Refract Surg 2007;23:742–743. DOI: https://doi.org/10.3928/1081-597X-20071001-02
Levy J, Lapid-Gortzak R, Klemperer I, Lifshitz T. Herpes simplex virus keratitis after laser in situ keratomileusis. J Refract Surg 2005;21:400–2. DOI: https://doi.org/10.3928/1081-597X-20050701-17
Nagy ZZ, Keleman E, Kovacs A. Herpes simplex keratitis after photorefractive keratectomy. J Cataract Refract Surg 2003;29:222–3. DOI: https://doi.org/10.1016/S0886-3350(02)02014-X
Wulff K, Fechner PU. Herpes simplex keratitis after photorefractive keratectomy. J Refract Surg 1997;13:613. DOI: https://doi.org/10.3928/1081-597X-19971101-06
Jarade EF, Tabbara KF. Laser in situ keratomileusis in eyes with inactive herpetic keratitis. Am J Ophthalmol 2001;132:779–80. DOI: https://doi.org/10.1016/S0002-9394(01)01092-3
De Rojas Silva MV, Díez-Feijóo E, Javaloy J, Sánchez-Salorio M. Prophylactic perioperative antiviral therapy for LASIK in patients with inactive herpetic keratitis. J Refract Surg 2006;22:404–6. DOI: https://doi.org/10.3928/1081-597X-20060401-19
Liu M, Song W, Gao W, et al. Impact of latent virus infection in the cornea on corneal healing after small incision lenticule extraction. Microorganisms 2023;11:2441. DOI: https://doi.org/10.3390/microorganisms11102441
Vryghem JC, Devogelaere T, Stodulka P. Efficacy, safety, and flap dimensions of a new femtosecond laser for laser in situ keratomileusis. J Cataract Refract Surg 2010;36:442-8. DOI: https://doi.org/10.1016/j.jcrs.2009.09.030

How to Cite

Leccisotti, A., Fields, S. V., De Bartolo, G., Crudale, C., & Posarelli, M. (2024). Keratorefractive lenticule extraction in eyes with post-herpetic scars. Laser Therapy, 31(1). https://doi.org/10.4081/ltj.2024.397
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.