Herpes Simplex Virus Keratitis in a University Tertiary Referral Centre – Clinical Features and Surgical Approaches

Abstract

Purpose To assess prevalence, clinical manifestations, required keratoplasties, follow-up, and outcome in patients with Herpes Simplex Virus Keratitis (HSK) attending a University Tertiary Referral Center. Design Retrospective (12 years), descriptive, observational study. Methods A total of 817 eyes with clinical diagnosis of HSK from 779 patients were classified by the type of presentation. We gathered data on the visual acuity, refraction, IOP, and required surgical procedures. Results Stromal involvement including scars represented the most common diagnosis in our department and the main indication of penetrating keratoplasty (PKP). Epithelial keratitis (16%) presented with the best visual acuity at the first visit. Necrotizing keratitis represented 17% of the patients, 78% of whom required PKP; this group also had the worst visual acuity at first examination and was the main indication for emergency PKP. Among all eyes, 288 (35%) required PKP. A total of 230 (28%) PKPs were elective procedures and 58 (7%) PKPs were performed as emergency procedures. Two patients with quiet endothelial decompensations after recurrent HSV endotheliitis were treated with DMEK and had good visual outcomes without HSV recurrence at last follow-up. Conclusions HSK is a prevalent disease with severe consequences when not treated appropriately and on time. Even when making an accurate diagnosis, the disease can be extremely aggressive, with all the implications it brings to the patients and health system. Elective PKP had better outcomes in terms of visual acuity and clear graft percentage compared to emergency PKP.

Infectious Crystalline Keratopathy after Penetrating Keratoplasty with Light and Electron Microscopic Examination

“…The whitish branching opacities are usually localized in the anterior corneal stroma, but deep stromal involvement has also been described in single cases 9 . In contrast to classical infectious keratitis 10 , 11 , 12 , 13 , ICK has an indolent and less aggressive but therapy-resistant clinical course.…”

Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation

“…Eyes with herpetic eye disease typically receive a normal size keratoplasty in the quiet interval after resolution of the infection and inflammation [12]. In cases of deep corneal ulcers, multilayer amniotic membrane transplantation (as "sandwich" i.e.…”

“…Perforated eyes need immediate treatment, and large perforations re- quire a PKP [23]. In cases of emergency PKP, the prognosis is worse than in elective surgery [12,22]. In the current cohort, emergency LDPKP in herpetic keratitis was performed because of corneal perforation in 5 out of 6 eyes.…”

“…Three herpetic keratitis eyes (50 %) remained with a clear transplant until the last visit. In the other cases, one patient underwent a repeat LDPKP, and in two more cases, another regular size PKP was recommended [12]. All eyes had a diagnosis of stromal necrotizing keratitis, and in five of them, the LDPKP was performed as an emergency PKP because of a perforated ulcer.…”

Histoacryl-Kleber zur Akutversorgung von Hornhautperforationen bei nekrotisierender herpetischer Keratitis

“…„metaherpetische Keratitis“) oder 5. (vaskularisierte) Hornhautnarben vorliegen [ 1 , 2 ]; 40 % der herpetischen Keratitis sind stromal (nekrotisierend 7 %, nicht nekrotisierend 93 %) [ 3 ]. Bei ulzerierender nekrotisierender stromaler Keratitis finden sich im Stroma im Bereich des Ulkus aktive und sich replizierende Viren [ 1 , 4 ].…”