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K.K. Chang, J.C. Affeldt; Latanoprost Associated Noninfectious Dendritiform Keratitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2620.
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Purpose: Latanoprost has been reported to promote recurrences of herpetic keratitis. We wish to document for the first time the clinical characteristics of a non–herpetic, dendritiform keratitis related to Latanoprost use. Methods: Case Report. Results: A middle aged woman with open–angle glaucoma with no previous history of ocular herpes simplex developed a bilateral branching epitheliopathy after starting Latanoprost therapy. The lesion was manifested by an opaque whitish elevated epithelial cell congregation, which formed rough branching dendritic figures without terminal bulbs. The lesion was limited to the inferocentral cornea, with the long axis oriented at 180 degrees. The lesion stained with fluorescein, and was broadly surrounded by a dense field of punctate keratopathy. Additionally, average central corneal sensation (Cochet–Bonnet esthesiometer) was intact, reflecting a non–neurotrophic environment. Following a negative viral culture, treatment was unsuccessfully attempted with oral acyclovir and aggressive lubrication in the form of punctal occlusion. Discontinuation of Latanoprost resulted in prompt resolution of the epitheliopathy. Conclusions: Not all keratopathies associated with Latanoprost use are of herpetic origin. Latanoprost associated noninfectious dendritiform keratitis appears to represent a variant of vortex keratopathy (cornea verticillata), which can be easily confused with dendritic herpes simplex or zoster keratitis. It can be distinguished clinically from its infectious counterparts however by its distinctive presentation including lesion color, location, orientation, and presence of surrounding punctate keratopathy field; as well as its rapid response to discontinuation of Latanoprost. This observation may help clarify the current controversy concerning the relationship of Latanoprost to apparent infectious herpetic keratitis.
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