Acute Stromal Keratitis Following the Vitrectomy for the Treatment of Myopic Tractional Maculopathy in Lupus

Abstract

Purpose: To report a case of acute stromal keratitis after vitrectomy for the treatment of myopic tractional maculopathy in a lupus patient.Case summary: A lupus patient who were treated with low dose steroid complained of decreased visual acuity due to myopic tractional maculopathy with fovea detachment. No evidence of intraocular inflammation was observed. The best-corrected visual acuity (BCVA) was 20/40. We performed the vitrectomy and removal of epiretinal membrane and internal limiting membrane. BCVA of 20/80 at day 1 decreased to hand motion at day 5. Severe corneal edema and superficial punctate keratitis that were observed did not improve three days after the anti-herpetic treatment. Based on this, we diagnosed her as immune-mediated acute stromal keratitis in lupus, and treated with oral methylprednisolone of 20 mg. The corneal edema improved rapidly following high dose systemic steroid. Myopic fovea detachment also improved. Improvement of BCVA was limited to 20/80 at six months, compared to the baseline one.Conclusions: We observed the development of acute stromal keratitis after vitrectomy for the myopic tractional maculopathy in the patient with lupus. High dose systemic steroid improved this corneal complication. Increased dose of systemic steroid should be considered before and after vitrectomy in lupus patients.