A 64-year-old woman presented to the emergency department with a 24-hour history of pain and decreased visual acuity (VA) in her left eye (LE).
She had a history of cataract surgery in her left eye for 6 months, and a Parkinsons disease under pharmacological treatment that she did not remember.
He had a corrected VA (cc) of count fingers to two meters in right eye (OD) and count fingers to one meter in left eye.
In the cleft palate, bilateral corneal edema, epithelial microbullae and stromal with Descemet folds were observed.
The right eye had a mature nuclear cataract.
In the OI, several small subepithelial infiltrates, white and rounded, with positive staining for fluorescein.
Intraocular pressure and eye fundus were normal.
1.
Initially, bilateral bullous keratopathy with infectious infiltrates in the left eye was diagnosed.
Treatment was established with vancomycin reinforced eye drops (50mg/ml) and ceftazidime (50mg/ml) every 2h in OI, and hypertonic sodium chloride eye drops (A).
At 48h of treatment there were no significant clinical or visual changes.
After a detailed anamnesis, we discovered the use of amantadine as an antiparkinsonian (Amantadine Level®), 100mg every 8h for 2 years, as well as a history of recurrent herpes labialis.
A diagnosis of suspected herpetic endotheliitis or drug toxicity secondary to amantadine was established.
A sample of aqueous humor was taken for the study with polymerase chain reaction (PCR) in herpes virus, in OAmicry, every 3h in oral cholera, every 3h in prednisolone eye drops every 8h.
An interconsultation with the neurology service was performed to remove amantadine, which was suspended one day later.
Four days later the VA cc was 0.1 in the RE and 0.16 in the LE, with slight improvement of bilateral corneal edema and disappearance of infiltrates in the LE, persisting central epithelial bullae.
The PCR study was negative, so the oral antiviral and reinforced eye drops were suspended.
1.
At 10 days the VA was 0.2 in RE and 0.16 in LE.
The edema had improved significantly, persisting Descemet folds and a central macrobulla in the left eye.
Pachymetry was 677μ in RE and 756μ in LE.
Treatment was reduced to prednisolone eye drops every 24h and Antiedema® every 8h in OA.
At 40 days the VA in RE was 0.3 (stenopeic 0.6) and 0.2 in LE, with complete resolution of corneal edema and presence of a paracentral leukoma in LE.
The pachymetry was 491 and 507μ, respectively.
Endothelial microscopy showed an endothelial density of 798 cells/mm2 in the RE and 853 cells/mm2 in the LE, without presence of metastases.
