New Therapeutic Perceptions in a Patient with Complicated Herpes Simplex Virus 1 Keratitis: A Case Report and Review of the Literature

Abstract

Patient: Male, 80Final Diagnosis: Unilateral complicated Herpetic Simplex Virus 1 KeratitisSymptoms: Visual impairmentMedication: Anti-herpetic treatment • Anti-VEGF • Cyclosporine A • Matrix regeneration therapyClinical Procedure: Amniotic membrane and limbal stem cell transplantationSpecialty: OphthalmologyObjective:Management of emergency careBackground:Keratitis caused by herpes simplex virus (HSV) can have detrimental effects on the cornea leading to loss of vision. Modern therapies can contribute to the prevention of anatomical and functional damage.Case Report:An 80-year-old male with complicated HSV-1 keratitis of the left eye (confirmed diagnosis after microbiological investigation) presented three months after antiviral treatment with corneal blurring, severe epitheliopathy, thinning of the stroma, and neovascularization. At the time he was referred, the visual acuity of his left eye was very low, as he could only count fingers at a one-foot distance. He was initially started on oral acyclovir (800 mg once daily) and topical poly-carboxymethyl glucose sulfate; afterwards he underwent amniotic membrane (AM) transplantation and localized treatment with anti-VEGF factors. One month after the AM transplantation there was an obvious improvement of the corneal surface. Ophthalmic suspension of cyclosporine-A 1% was also added to his treatment. After three months, a transplantation of stem cells (deriving from the sclerocorneal junction of his right eye) was carried out at the sclerocorneal junction, as the corneal damage and neovascularization was more severe at this anatomical area. Four months after the last surgery, his visual acuity was 1/10 (note, he had a history of an old vascular episode) and the cornea was sufficiently clear with no signs of epitheliopathy and almost complete subsidence of the neovascularization.Conclusions:Transplantation of AM and stem cells in combination with anti-VEGF factors and topical administration of cyclosporine-A 1% and poly-carboxymethyl glucose sulfate (a regenerative factor of corneal matrix) contributed substantially in the management of herpetic keratitis complications.

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

“…Keratitis caused by the herpes simplex virus (HSV) including epithelial, stromal, and endothelial keratitis can have detrimental effects on the cornea, leading to loss of vision . Herpes simplex keratitis (HSK) is characterized by a high risk of relapse that increases over time .…”

“…After several recurrences, the corneal haze gradually worsens and may even lead to corneal perforation . Herpes simplex keratitis is a common pathogeny of corneal disease and one of the leading causes of infectious corneal blindness worldwide . Currently, the main treatments of HSK are topical and oral agent antiviral drugs that inhibit the replication of the virus in the cornea .…”

“…4 Herpes simplex keratitis is a common pathogeny of corneal disease and one of the leading causes of infectious corneal blindness worldwide. 1 Currently, the main treatments of HSK are topical and oral agent antiviral drugs that inhibit the replication of the virus in the cornea. 5 However, in order to preserve the eyeball and recover corneal clarity, surgical intervention may be required for patients with corneal dissolution or long-term complications such as ulcers, necrotizing keratitis, and neurotrophic keratitis.…”

Protective effect of total flavonoids from Ixeris Sonchifolia on herpes simplex virus keratitis in mice

“…In order to develop new drugs with low toxicity, high efficiency and no drug resistance, the research of TCM has become a hotspot for disease treatment [33]. The antiviral mechanism of TCM preparations, on the one hand, may be related to the direct elimination of viruses or induction of interferons, reduction or blocking of the translation of viral RNA, on the other hand, it may be related to the adjustment of the immune system and the enhancement of immune function, while the latter seems more important [34,35]. TCM has its advantages in adjusting immune function, strengthening the body and eliminating pathogens.…”

Heparanase, cell signaling, and viral infections

“…Upregulation of VEGF during an ocular HSV-1 infection can lead to corneal neovascularization, and elevated VEGF levels during DENV infections contribute to dengue hemorrhagic fever [71,72]. Inhibiting VEGF reduces the severity of viral infection and tumor growth [73][74][75].…”