Case 3 presentation
contributed by
PD Dr. Tobias Stupp, Meerbusch, Germany and Dr. Philipp Franko Zeitz, Düsseldorf, Germany
Categories: Cornea, infections, herpetic disease, surface disorders
Key problem: Multiple different findings that need treatment, but the therapy for one will worsen the other
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Female, 65 years old
History of metastasized ovarian carcinoma with recent chemotherapy (gemcitabine, carboplatin, bevacizumab, premedication: ondansetron, aprepitant, ranitidine, dexamethasone)
First examination (day 1)
Anterior segment: OS herpetic keratitis with multiple dendritis ulcerations (see photo), otherwise within normal limits
Therapy: Aciclovir ointment five times a day
Second examination (4th week)
Anterior segment: OS good improvement of the herpetic alterations with no more dendritic ulcerations visible, but now remarkable inhomogenous opacities in the upper cornea with dotted fluoresceine staining and a demarcation line with fluoresceine pooling at the inferior edge (see photo)
Therapy: Aciclovir stopped, artificial tears every two hours
Third examination (12th week)
Anterior segment: OS unchanged on fluoresceine staining, but now progressive corneal vascularization (see photo)
How would You proceed at this point?
