Journal List > J Korean Ophthalmol Soc > v.48(9) > 1007919

Hwang, Wee, Lee, and Kim: Clinical Analysis of Herpetic Keratitis in Korea

Abstract

Purpose

To investigate the clinical characteristics of herpetic keratitis in Korea

Methods

A retrospective analysis was performed on 90 eyes of 84 patients who were clinically diagnosed with herpetic keratitis and were followed for at least 4 months or more. Information on prior herpetic keratitis, type of keratitis, time to remission, recurrence rate, administration of oral acyclovir, final visual acuity was reviewed. Remission time and recurrence rate were compared according to types of herpetic keratitis and the application of oral acyclovir in epithelial, stromal or endothelial keratitis; and the relation of history of previous herpetic keratitis, recurrence and final vision, was analyzed.

Results

Sex ratio (M:F) was 1.31 and the mean age was 54.6 years. Of 90 eyes, the proportion of infectious epithelial keratitis, stromal keratitis, endothelitis and neurotrophic ulcer was 51.1, 17.8, 25.6 and 5.6%, respectively. The mean remission time was 1.92±1.01, 4.13±5.05, 5.52±5.08, 4.00±1.00, respectively (p=0.001, one-way Anova). Recurrence occurred in 21 (42.9%) eyes of 49, which were followed up for more than 12 months, in a year after the previous attack. The rates of recurrence of infectious epithelial keratitis, stromal keratitis and endothelitis were 25.0%, 63.6% and 53.8%, respectively. Oral acyclovir neither shortens the remission nor prevents the recurrence. The percentage of final vision over 20/40 in infectious epithelial keratitis, stromal keratitis and endothelitis was 81.1, 57.1 and 60.0%, respectively. The final vision was worse in the group with a history of herpetic keratitis.

Conclusions

Stromal keratitis and endothelitis showed a higher recurrence rate and longer remission time than infectious epithelial keratitis. Because recurrent and severe keratitis may result in corneal opacity and vision loss, aggressive and proper treatment is needed. However, these cases are often resistant to therapy.

References

1. Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea. 2001; 20:1–13.
crossref
2. Liesegang TJ, Melton LJ 3rd, Daly PJ, Ilstrup DM. Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982. Arch Ophthalmol. 1989; 107:1155–9.
3. Kaye S, Choudhary A. Herpes simplex keratitis. Prog Retin Eye Res. 2006; 25:355–80.
crossref
4. The Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus. Arch Ophthalmol. 1996; 114:1065–72.
5. Margolis TP, Ostler HB. Treatment of ocular disease in eczema herpeticum. Am J Ophthalmol. 1990; 110:274–9.
crossref
6. Schwartz GS, Holland EJ. Oral acyclovir for the management of herpes simplex virus keratitis in children. Ophthalmology. 2000; 107:278–82.
crossref
7. Byon IS, Lee JE, Lee JS. Treatment of herpes simplex ocular disease with ganciclovir ophthalmic gel. J Korean Ophthalmol Soc. 2005; 46:164–70.
8. Lee GU, Lee JH. Corticosteroid therapy in herpes simplex virus keratitis. J Korean Ophthalmol Soc. 1986; 27:493–6.
9. Kim HI, Chung SK, Myong YW, Rhee SW. Clinical evaluations of recurrence after keratoplasty in herpes simplex keratitis. J Korean Ophthalmol Soc. 1992; 33:209–15.
10. Sudesh S, Laibson PR. The impact of the herpetic eye disease studies on the management of herpes simplex virus ocular infections. Curr Opin Ophthalmol. 1999; 10:230–3.
crossref
11. The Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. The Epithelial Keratitis Trial. Arch Ophthalmol. 1997; 115:703–12.
12. The Herpetic Eye Disease Study Group. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med. 1998; 339:300–6.
13. The Herpetic Eye Disease Study Group. Oral acyclovir for herpes simplex virus eye disease: effect on prevention of epithelial keratitis and stromal keratitis. Arch Ophthalmol. 2000; 118:1030–6.
14. Hong WS, Rhee SW. Clinical observation of herpes keratitis. J Korean Ophthalmol Soc. 1977; 18:129–33.
15. Song YK, Chang HK. Clinical effect of acyclovir therapy on herpetic keratitis. J Korean Ophthalmol Soc. 1989; 30:357–61.
16. Mathers WD, Jester JV, Lemp MA. Return of human corneal sensitivity after penetrating keratoplasty. Arch Ophthalmol. 1988; 106:210–1.
crossref
17. Matsumoto Y, Dogru M, Goto E, et al. Autologous serum application in the treatment of neurotrophic keratopathy. Ophthalmology. 2004; 111:1115–20.
18. Wilhelmus KR, Coster DJ, Donovan HC, et al. Prognosis indicators of herpetic keratitis. Analysis of a five-year observation period after corneal ulceration. Arch Ophthalmol. 1981; 99:1578–82.
19. Bell DM, Holman RC, Pavan-Langston D. Herpes Simplex keratitis: epidemiologic aspects. Ann ophthalmol. 1982; 14:421–4.
20. Darougar S, Wishart MS, Viswalingam ND. Epidemiological and clinical features of primary herpes simplex virus ocular infection. Br J Ophthalmol. 1985; 69:2–6.
crossref
21. Collum LM, Benedict-Smith A, Hillary IB. Randomized double-blind trial of acyclovir and idoxuridine in dendritic corneal ulceration. Br J Ophthalmol. 1980; 64:766–9.
22. Pavan-Langston D, Lass J, Hettinger M, Udell I. Acyclovir and vidarabine in the treatment of ulcerative herpes simplex keratitis. Am J Ophthalmol. 1981; 92:829–35.
crossref
23. Collum LM, O'Connor M, Logan P. Comparison of the efficacy and toxicity of acyclovir and of adenine arabinoside when combined with dilute betamethasone in herpetic disciform keratitis: preliminary results of a double-blind trial. Trans Ophthalmol Soc U K. 1983; 103:597–9.
24. Wilhelm us KR, Gee L, Hauck WW, et al. Herpetic Eye Disease Study. A controlled trial of topical corticosteroids for herpes simplex stromal keratitis. Ophthalmology. 1994; 101:1883–95.
25. Cunningham ET Jr.Diagnosing and treating herpetic anterior uveitis. Ophthalmology. 2000; 107:2129–30.
crossref
26. Souza PM, Holland EJ, Huang AJ. Bilateral herpetic keratoconjunctivitis. Ophthalmology. 2003; 110:493–6.
crossref
27. Takahashi GH, Leibowitz HM, Kibrick S. Topically applied steroids in active herpes simplex keratitis. Effect in rabbits. Arch Ophthalmol. 1971; 85:350–4.
28. Holland EJ, Brilakis HS, Schwartz GS. Herpes Simplex Keratitis. In : Krachmer JH, Mannis MJ, Holland EJ, editors. Cornea. 2nd ed.Philadelphia: Elseview Mosby;2005. v. 1. chap. 83.
29. la Lau C, Oosterhuis JA, Versteeg J, et al. Acyclovir and trifluorothymidine in herpetic keratitis. Preliminary report of a multicentered trial. Doc Ophthalmol. 1981; 50:287–90.
30. Shuster JJ, Kaufman HE, Nesburn AB. Statistical analysis of the rate of recurrence of herpesvirus ocular epithelial disease. Am J Ophthalmol. 1981; 91:328–31.
crossref
31. Barney NP, Foster CS. A prospective randomized trial of oral acyclovir after penetrating keratoplasty for herpes simplex keratitis. Cornea. 1994; 13:232–6.
crossref
32. Simon AL, Pavan-Langston D. Long-term oral acyclovir therapy. Effect on recurrent infectious herpes simplex keratitis in patients with and without grafts. Ophthalmology. 1996; 103:1399–404.
33. Barron BA, Gee L, Hauck WW, et al. Herpetic Eye Disease Study. A controlled trial of oral acyclovir for herpes simplex stromal keratitis. Ophthalmology. 1994; 101:1871–82.

Figure 1.
Figure 1. Comparison of the mean remission time between various types of herpetic keratitis, and the effect of oral acyclovir on remission time. Error bar: ±2 standard deviation. Group I: Infectious epithelial keratitis. II: Stromal keratitis. III: Endothelitis. IV: Neurotrophic keratitis. p: Independent t-test between oral acyclovir-administered group and not-administered group.
jkos-48-1212f1.tif
Figure 2.
Recurrence of herpetic keratitis: Survival analysis by Kaplan-Meier test between the patients with oral acyclovir administration and without administration. Logrank test: p=0.28.
jkos-48-1212f2.tif
Table 1.
Comparison of number of eyes with herpetic keratitis recurrence in 1 year and recurrence rate between various types of herpetic keratitis and the effect of oral acyclovir
Oral acyclovir Mean recurrence rate (per year) No. of eye with recurrence (total number of eyes) p
Group I 0.21 3 (11) 0.604
+ 0.37 2 (9)
Group II 0.36 3 (4) 0.530
+ 0.57 4 (7)
Group III 0.86 3 (6) 0.617
+ 0.46 4 (7)
Group IV 0.63 1 (2) 0.700
+ 0.62 1 (3)
Total 0.44 10 (23) 0.581
+ 0.48 11 (26)

Forty-nine eyes with follow up over 12 months were analyzed.

Group I: Infectious epithelial keratitis, II: Stromal keratitis, III: Endothelitis, IV: Neurotrophic keratitis.

Oral acyclovir +: oral acyclovir administered, -: not administered.

: Chi square between the groups with and without oral acyclovir administration.

Table 2.
Comparison of final vision between various types of herpetic keratitis; the effect of history of previous herpetic keratitis to final vision
History of previous herpetic keratitis Final visual acuity
p
≥20/40 <20/40
Group I + 1 eyes 4 0.002
29 3
Group II + 3 5 0.121
5 1
Group III + 4 8 0.038
8 2

Group I: Infectious epithelial keratitis, II: Stromal keratitis, III: Endothelitis.

+: Eyes with past history of herpetic keratitis, -: Eyes without past history of herpetic keratitis.

p: Fisher's exact test (between past history of herpetic keratitis and visual acuity).

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