Herpes Simplex Virus Endotheliitis following Descemetʹs Membrane Endothelial Keratoplasty

Purpose: To report a case of herpes simplex virus (HSV) endotheliitis following simultaneous phacoemulsification, intraocular lens (IOL) implantation and descemet’s membrane endothelial keratoplasty (DMEK). Case Report: A 45 year‑old female with corneal endothelial decompensation and a mature cataract, and history of anterior uveitis underwent simultaneous phacoemulsification, IOL implantation and DMEK. Increased corneal edema and descemet’s membrane (DM) detachment occurred on postoperative day 3 and 5, respectively. One week after surgery, active keratic precipitates (KPs) appeared. Polymerase chain reaction (PCR) analysis was performed on an aqueous sample which was positive for herpes simplex virus (HSV). After initiating oral acyclovir and frequent topical corticosteroids, the corneal edema resolved and the donor tissue became spontaneously reattached to the recipient corneal stroma. Conclusion: HSV endotheliitis may occur in the early postoperative period after DMEK and manifest as endothelial dysfunction leading to donor detachment. Anti‑viral medication may help treat the acute phase and reduce the risk of recurrence.