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Titre	Management of post-viral ulcer
Abstract Nr.	1029

But	A 22-years-old woman followed for a recurrent herpetic keratitis on the right eye. In 2012 she developed a stromal herpes keratitis ending in a spontaneous perforation. A perforating keratoplasty was performed. A rigid contact lens was worn but 10 months later an herpetic corneal ulcer appeared with a central thin and fragile graft.
Méthodes	A second perforating graft was performed on the right eye under cover for Herpes Simplex Virus with a prophylactic dose of valacyclovir 500mg 2x/day. After 2 weeks a new ulcer developed. It grew to the depth of stroma with corneal hypoesthesia and almost complete vision loss. The ulcer progressed to 7.5mm by 4.5mm with only 164 microns of posterior stroma in the thinest point after 2 months. Most of the corneal points were removed to limit inflammation. A cure with polycarboxyméthylglucose (Cacicol®) 1x/48h was started. All other topical drops were stopped to avoid toxicity.
Résultats	Half of the surface was closed only 8 days after the first instillation. The ulcer was completely closed 1 month after the first instillation. Valacyclovir, topical fluorometholone and polycarboxyméthylglucose were continued for months. Nine months after the first installation, there was no pain, the right eye stayed white without inflammation, the cornea was quasi healed. The new pachymetry in the center was 301 microns, the cornea was rather clear. The visual acuity was 2/10 with correction. Polycarboxyméthylglucose was stopped and topical fluorometholone continued 3x/day. After 18 months, the patient recovered a normal thickness cornea with a central scar. Her state is still stable.
Conclusion	Polycarboxyméthylglucose with fluorometholone was effective in reepithelialization of a large herpetic corneal ulcer on a perforating keratoplasty

Auteur 1

Nom	REMONT
Initiales	LR
Institut	CHU de Liège
Ville	Liège