Herpetic Keratouveitis following Intravitreal Ranibizumab Injection in a Case with Diabetic Macular Edema

Purpose: The purpose of this study is to report a case of herpetic keratouveitis that developed soon after intravitreal ranibizumab injection.

Case report: A 54-year-old man with bilateral proliferative diabetic retinopathy and severe macular edema received intravitreal ranibizumab injections in both eyes within 3 days interval. One week after the injection, patient presented with acute vision loss in his right eye. Slit-lamp biomicroscopy revealed diffuse corneal edema and severe flare in the anterior chamber with intraocular pressure (IOP) rise. After epithelial dendritic corneal ulcer was visualized, he was diagnosed with right herpetic keratouveitis that was treated with oral valacyclovir, as well as topical acyclovir ointment and prednisolone acetate drops. However, recalcitrant IOP rise had to be treated with a single session transscleral diode laser cyclophotocoagulation.

Conclusion: Herpetic keratouveitis can be seen as a rare complication of intravitreal ranibizumab injection. To our best knowledge, this is the first case with herpes keratouveitis developed following intravitreal ranibizumab injection.

Keywords: Diabetic macular edema; herpes simplex virus; herpetic keratouveitis; intravitreal injection; ranibizumab.