Recurrence of herpes simplex virus keratitis following intravitreal steroid injection

A 69-year-old diabetic male with a prior history of herpes simplex virus (HSV) keratitis presented with reduced vision in his right eye due to diabetic macular edema, which was unresponsive to intravitreal anti-vascular endothelial growth factor injections [Fig. 1a]. He was on oral Acyclovir prophylaxis. After receiving a dose of intravitreal triamcinolone acetonide, he developed HSV epithelial keratitis [Fig. 1b]. He was treated with oral Acyclovir 400 mg five times a day, which resulted in the resolution of the ulcer. The macular edema also responded to the intravitreal steroid injection [Fig. 1c and d]. The recurrence was attributed to local immunosuppression caused by the steroid.[1,2]Figure 1: (a) Optical coherence tomography suggestive of diabetic macular edema. (b) Dendritic ulcer positive for fluorescein stain. (c) Optical coherence tomography suggestive of resolved diabetic macular edema. (d) Healed viral keratitisAuthor contributions Conceptualization: N.K.S.; Data curation: N.J.; Writing—original draft preparation: N.J.; Writing—review and editing: N.K.S., A.K.; Supervision: N.K.S., A.K. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: The study was supported by the Hyderabad Eye Research Foundation (HERF). Conflicts of interest: There are no conflicts of interest.