Clinical Analysis of Herpetic Keratitis in Korea

Joon Seo Hwang; Won Ryang Wee; Jin Hak Lee; Mee Kum Kim

doi:10.3341/jkos.2007.48.9.1212

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

Original Article

J Korean Ophthalmol Soc 2007;48(9):1212-1219.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.9.1212

Clinical Analysis of Herpetic Keratitis in Korea

Joon Seo Hwang, M.D.^1,², Won Ryang Wee, M.D.^1,², Jin Hak Lee, M.D.^1,³, Mee Kum Kim, M.D.^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

³Department of Ophthalmology, Seoul National University Bundang Hospital, Gyeonggi, Korea

Address Reprint requests to Mee Kum Kim, M.D., Department of Ophthalmology, Seoul National University College of Medicine, #28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea, Tel: 82-2-2072-2665, Fax: 82-2-741-3187, E-mail : kmk9@snu.ac.kr

Received 8 December 2006 Accepted 7 June 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Herpes simplex keratitis, Oral acyclovir, Recurrence, Visual loss, Stromal keratitis

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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.

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.

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
	History of previous herpetic keratitis	≥20/40	<20/40	p
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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