Clinical Features of Herpes Simplex Keratitis in a Korean Tertiary Referral Center: Efficacy of Oral Antiviral and Ascorbic Acid on Recurrence

Abstract

PurposeTo describe the clinical manifestations of herpes simplex keratitis (HSK) in a tertiary referral center in South Korea and to determine whether ascorbic acid treatment prevents recurrence of herpetic epithelial keratitis.MethodsThis retrospective cohort study included all consecutive patients with herpetic keratitis referred to our center from January 2010 to January 2015. Clinical features, ocular complications, and recurrences were recorded.ResultsIn total, 149 eyes of the 133 patients (72 male and 61 female) were followed for an average of 24.6 ± 13.2 months. Sixteen (12.0%) patients had bilateral HSK. The most frequent HSK subtype was epithelial keratitis (49.7%), which was followed by stromal keratitis (23.5%). Epithelial keratitis was the most likely subtype to recur. Complications occurred in 122 (81.9%) eyes. The most common complication was corneal opacity. Recurrences were observed in 48 (32.2%) eyes. The recurrence rates were lower in the prophylactic oral antiviral agent group (16 / 48 eyes, 33.3% vs. 49 / 101 eyes, 48.5%) and the ascorbic acid treatment group (13 / 48 eyes, 27.1% vs. 81 / 101 eyes, 70.3%) compared with the groups without medications. Univariate logistic regression analysis revealed that both factors significantly reduced the risk of recurrence (acyclovir: odds ratio, 0.25; 95% confidence intervals, 0.12 to 0.51; ascorbic acid: odds ratio, 0.51; 95% confidence intervals, 0.20 to 0.91).ConclusionsThis retrospective study described the clinical findings of HSK in a tertiary referral center in South Korea. Prophylactic oral antiviral agent treatment and oral ascorbic acid administration may lower the risk of recurrence.

Overview of the possible role of vitamin C in management of COVID-19

“…However, it significantly decreased the incidence of post-herpetic neuralgia [ 24 ]. In a retrospective study, it was found that the concentration of vitamin C in aqueous humour in the anterior chamber of the eye increased following oral supplementation of vitamin C [ 25 ]. Moreover, prophylactic oral antiviral and vitamin C decreased the recurrence rate of herpes simplex keratitis.…”

The antiviral properties of vitamin C

“…Vitamin C is concentrated in the aqueous humor of the anterior chamber of the eye. A retrospective cohort study indicated that oral vitamin C reduced the risk of herpes simplex keratitis recurrence particularly in combination with oral antiviral therapy [33].…”

Repositioning Vitamin C as a Promising Option to Alleviate Complications associated with COVID-19

“…In an animal model, a reduced number of marmosets treated with vitamin C were infected with parainfluenza virus, whereas all the control animals were infected, suggesting the beneficial effect of vitamin C against the parainfluenza infection [ 101 ]. A retrospective study on the effect of ascorbic treatment on herpes simplex virus-induced keratitis patients suggested that administration of oral ascorbic acid along with prophylactic anti-viral agent treatment may lower the risk of recurrence [ 102 ]. Intravenous vitamin C treatment showed good recovery in patients clinically infected with Herpes Zoster virus [ 103 104 ].…”