Stromal keratitis following selective laser trabeculoplasty

A 77-year-old man presented with stromal keratitis that began shortly after he had selective laser trabeculoplasty (SLT). The patient had no history of keratitis. One week after SLT, the corrected distance visual acuity (CDVA) had decreased from 20/25 to 20/40. Anterior segment optical coherence tomography (AS-OCT) showed near full-thickness corneal stromal opacification without thinning. The patient was empirically treated for herpes simplex virus keratitis with oral antiviral and topical corticosteroid medications. He ultimately developed a corneal scar, and 1 year after the procedure, the CDVA stabilized at 20/50. Although uncommon, keratitis after SLT can be an idiopathic condition or the result of herpes virus reactivation. This case shows the diagnostic challenge associated with diagnosing and managing post-SLT keratitis and is 1 of the first cases of this type using corneal imaging obtained with AS-OCT.