Herpes simplex virus stromal keratitis and endotheliitis after femtosecond laser–assisted cataract surgery and astigmatic keratotomy

Two weeks after uneventful femtosecond laser–assisted cataract surgery (FLACS) with laser astigmatic keratotomy (AK) in the right eye, a 72-year-old woman developed a corneal ulcer and infiltrate in the superonasal AK incision, with severe anterior chamber reaction. She was initially treated for bacterial followed by fungal keratitis, without resolution. She was referred to our university corneal service for consultation. Based on clinical presentation and slitlamp examination, the patient was diagnosed with herpes simplex virus keratitis (HSK). The patient was administered topical steroid eyedrops and systemic antiviral therapy, with full resolution of the keratitis. To the authors’ knowledge, this is the first reported case of herpes simplex virus stromal keratitis and endotheliitis after FLACS combined with AK. This report postulates about possible etiologic factors for activation of HSK after femtosecond laser treatment and proposes preventative actions.