Case 3 presentation
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
In contrast to other case reports that You might know, we want to present expert-level cases that do not have a clear and proper solution. We do this because we believe that a case report with just one specific solution will only add more encyclopedic knowledge to Your repertoire, while an open-ended case report with a discussion will train Your methods.
Therefore each case highlights one specific problem that is expressed in the introduction.
Don´t be afraid to send Your opinion even if You do not know the "right" answer:
These cases are meant to be tough and there is no "right answer"!
Therefore we can not offer You the satisfying feeling of solving a puzzle correctly, but something more valuable: You will train Your skills by developing a proper method for "how to proceed" and You will help others to train their skills by giving them your different perspective.
So we want to invite You to participate - You may also stay anonymous, if You wish so!
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?