Бетагерпетические кератиты. Обоснование диагноза и тактики ведения пациентов

Abstract

Relevance. This publication presents an algorithm for the management of patients with recurrent keratitis associated with betaherpesviruses and outlines the possibilities of laboratory and instrumental diagnostics. Purpose. To systemize the algorithm for the management of patients with superficial keratitis associated with betaherpesviruses confirmed by confocal microscopy. Material and methods. A group of 21 patient (21 eye) with superficial keratitis associated with betaherpesviruses was under observation during 12 months. The diagnosis was made on the basis of confocal microscopy results, clinical picture and results of laboratory tests. Each patient received a two-stage treatment with nucleoside analogues locally and systemically; treatment with anti-inflammatory and reparative medicine. Results. Remission as a result of the treatment was achieved in 20 of the 21 patients. Conclusion.The only reliable diagnostic method of keratitis associated with betaherpesviruses is a confocal microscopy, with identification of betaherpesvirus specific «owl's eye» cells. In view of frequent recurrence leading to increase of cornea opacity area, therapy of keratitis associated with betaherpesviruses requires a two-stage treatment. In first stage it is mandatory to prescribe increased dosages of nucleoside analogues, second stage requires prescription of local glucocorticoids and long-term reparative treatment. Key words: keratitis, herpesviruses, cytomegalovirus, human herpesvirus 6, «owl's eye» cells