Cataract & Refractive Surgery Today – Herpes Simplex Virus Keratitis

This may also present as geographic herpes, one step up from a dendritic keratitis, in which sloughing of the epithelium occurs in the areas between the dendrite. Primary ocular HSV infection [Table – 2] most commonly manifests as blepharoconjunctivitis which is predominantly unilateral. for three days, meaning the entire standard treatment lasts about two weeks. Following a primary infection, the disease may recur in the cornea and may result in epithelial keratitis. Significant anterior chamber inflammation may accompany stromal keratitis. These infections will usually settle on their own in 1-3 weeks.

Inevitably, a herpes patient will nervously rattle off a series of rapidfire questions: Is it a sexually transmitted disease? While IFN-γ is of crucial importance in maintaining the virus in a latent state and preventing reactivation, in vitro studies showed that type I IFNs may be of importance during establishment of latency [6]. Now, because of the VZV vaccine, many kids don’t actually get chickenpox. History of recurrent episodes of keratitis, any exacerbating or precipitating factors, and any associated systemic illness was recorded. Robert Hendricks, University of Pittsburgh, Pittsburgh, PA) were used for ocular challenge. Following re-epithelialization, treatment for an additional 7 days of one drop every 4 hours while awake for a minimum daily dosage of five drops is recommended, Dr.


All samples from the control group were negative by Giemsa and PCR; however, one sample was reported positive in IFA. DNA was extracted from all specimens using a viral nucleic acid mini kit (Qiagen, Hilden, Germany). This is done to assure the right diagnosis and to known is the eye infection is in the upper layer of the cornea or in the deeper parts of the eye. This inhibits viral DNA synthesis by slowing the viral DNA chain.22 The affinity of ganciclovir for viral TK renders it more specific in its action than TFT and, consequently, less toxic to normal cells and more tolerable to patients. for 12 months) greatly reduces the recurrence of HSV epithelial and stromal keratitis and showed that long-term antiviral prophylaxis was most beneficial for patients with a history of HSV stromal keratitis.1,4 Because various factors have been associated with the reactivation of HSV (ie, surgery, trauma, physical/emotional stress, fever, UV exposure, etc.), the benefits of instituting an antiviral prophylactic regimen and continuing it long term in this patient would certainly outweigh the limited risks associated with these medications. At the first presentation, the patients were treated with topical (four times daily) and systemic (5×400 mg daily) aciclovir and lubricants.

But there are instances that require immediate referral to a cornea specialist to make sure the patient doesn’t go downhill quickly. Postoperative topical prednisolone acetate 0.1% eye drops (averaging 4 times daily and subsequently tapered) were used in all patients. External disease and cornea. Curr Opin Ophthalmol. In Nd-YAG procedure, laser was applied slightly posterior to the lens to avoid pitting of the lens. Because of the high prevalence of positive HSV antibodies in most populations, serology is only helpful in the diagnosis in that a negative HSV antibody titer will rule out the possibility that iritis is due to HSV.

Steinert said that his dry eye patients get the most benefit—both pre- and postoperatively—from artificial tears if they instill preservative-free tears both liberally and, importantly, before they experience any discomfort related to their dry eye disease. Following PCR, the amplicon (221 bp) was resolved on a 1.5% agarose/TAE gel, visualised using ethidium bromide (0.5 μg/ml) under ultraviolet illumination, and recorded using the ultraviolet gel documentation system (UVI Tec Ltd, Cambridge, UK). Charts were reviewed for the following information: disease-free time before surgery, quadrants of pre-operative host vascularity, HSV recurrence, allograft rejection, allograft failure, and histopathologic presence of inflammation and neovascularization in the excised corneal tissue. The HSV‐1 DNA load in the corneas of patients with HK correlated with age, the recurrence‐free interval, cornea neovascularization, steroid treatment before PKP, and disease severity. The mean age of presentation was 51.53 years. After a week of antiviral treatment, in vivo confocal microscopy examination demonstrated an irregular epithelium with highly reflective deposits and reflective areas.

While use of ganciclovir was associated with a better outcome than acyclovir, similar healing rates were found at 7 days. de Luise said.