Herpetic Epithelial Keratitis Research Articles

L-lysine as a Possible Supplement for Treatment of Herpetic Epithelial Keratitis: A Case Report and Literature Review

L-lysine as a Possible Supplement for Treatment of Herpetic Epithelial Keratitis: A Case Report and Literature Review

Long-term Follow-up Results after Prophylactic Antiviral Administration in Patients with Herpes Simplex Keratitis

Purpose: We analyzed the effectiveness of prophylactic oral antivirals in preventing herpes simplex keratitis (HSK) and the clinical manifestations of recurrence.Methods: A retrospective analysis was conducted on 30 eyes of 30 patients diagnosed with HSK who received prophylactic oral antiviral agents for > 6 months. We analyzed the initial and recurrent clinical features of HSK, the recurrence rate, and the relationship between recurrence and the duration of oral antivirals.Results: The mean age of the patients was 64.5 ± 14.0 years, and the mean follow-up duration was 72.4 ± 40.3 months. Of the 30 eyes, 21 (70%) experienced HSK recurrence. The initial clinical features of recurrent cases included herpetic epithelial keratitis (14.3%), stromal keratitis (47.6%), and endotheliitis (38.1%). Notably, no significant associations were observed between the initial clinical features of HSK or the duration of oral antivirals and HSK recurrence. However, male patients exhibited a significantly higher recurrence rate. Epithelial keratitis (47.6%) was the most common HSK type observed during recurrence.Conclusions: A recurrence rate of 70% was observed in patients who received prophylactic oral antiviral treatment for > 6 months. Herpetic epithelial keratitis was the most common clinical phenotype after recurrence. Notably, long-term clinical monitoring could assist in predicting and preventing recurrence.

Herpetic keratitis mimicking chronic limbal stem cell failure

To describe four cases of herpetic keratitis after cultivated limbal stem-cell transplantation (CLET). Four patients affected by limbal stem cell deficiency (LSCD) caused by alkali burns received CLET. During regular follow-up, epithelial defects were detected and corneal scraping was performed to identify active viral keratitis. Herpetic epithelial keratitis was successfully diagnosed by corneal scraping and polymerase chain reaction of HSV-1 DNA in all four patients affected by epithelial defects. The defects resolved after appropriate therapy with topical and/or systemic antiviral drugs. Epithelial defects due to herpetic keratitis after cultivated limbal stem-cell transplantation may mimic chronic stem-cell deficiency. A low-threshold for corneal scraping can yield rapid identification of herpetic viral DNA allowing for appropriate treatment.

Keratitis Herpetik Keratit Geçmişi Olmadan Penetran Keratoplasti Sonrası Yeni Edinilmiş Herpetik Epitelyal Keratit

Objective: Herpes simplex virus (HSV) infection may develop either by reactivation of latent HSV in its endogenous foci or exogenous transmission from the transplanted donor cornea after penetrating keratoplasty (PK). In the current study, we aimed to determine the clinic and treatment outcomes of patients without previous history of HSV infection who had newly acquired herpetic epithelial keratitis (HK) after PK. Material and Methods: The medical records of patients who underwent PK for reasons outside of corneal scars due to the HK between January 1995 and February 2016 were retrospectively screened. Results: The incidence of newly developed HK was 1.09% (17/1559). The mean interval between PK and HK was 30.41±39.31 months (range 1-139 months). Dry eye was present in 82.3%, corneal neovascularization in 41.2% and systemic diseases in 23.5% cases with newly acquired HK after PK. At the time of the diagnosis of HK; 82.3% of cases were using topical steroids, 23.5% of cases oral steroids and 11.8% of cases topical cyclosporine-A. In 17.6% cases HK developed after the secondary surgeries following PK. Conclusion: The diagnosis of HK immediately came to mind and treatment was started at once especially in persistent and atypical epithelial defect on corneal grafts. Herpetic epithelial keratitis should be remembered that it can be develop any time after PK.

Herpetic endothelial dendrite

To our knowledge, we report the first case of a herpetic endothelial dendrite in a patient with known herpetic keratitis. The patient had been treated with topical antivirals for herpetic epithelial dendritic keratitis. When the epithelial dendrites had resolved, the new endothelial dendrite appeared. The adjacent cornea was not edematous; however, the apparent endotheliitis was treated with oral antivirals and topical steroids until resolution.

Input of recombinant phenotyping for the characterization of a novel acyclovir-resistance mutation identified in a patient with recurrent herpetic keratitis

We report here a case of an immunocompetent patient suffering from recurrent epithelial herpetic keratitis associated with the emergence of antiviral resistance. Indeed, the not previously described amino acid change L340R within herpes simplex virus thymidine kinase, was shown to confer acyclovir-resistance by recombinant phenotyping using bacmid technology.

The Effectiveness of Ganciclovir Comparing with Combination Therapy of Oxytetracycline HCI and Polymyxin B Sulfate in Herpetic Epithelial Keratitis

Introduction: Herpes simplex virus is a common keratitis agent. There are two different types of virus, type 1 and 2. Type 1 shows three main clinical pictures in cornea: epithelial herpetic keratitis, stromal keratitis, disciform keratitis. The aim of this study is to reduce the duration of herpetic keratitis treatment and eliminate the risk of complications. Material and Methods: Between January 2017 and January 2018, 29 patients with herpetic keratitis were included in the study. In the first group, the herpetic membrane was removed by a single shot on the herpetic lesion with the yag laser. Then, topically oxytetracycline hydrochloride+polymyxin B sulfate was applied. The second group was treated with topical antiviral therapy (Ganciclovir). After treatment, daily follow-up of patients, vision, tonus, fundus diameters and recovery times were noted and the data were compared statistically. Results: In group I and group II, the age of the patients did not differ significantly (p> 0.05). In group I and group II, the gender distribution of the patients did not differ significantly (p>0.05). In Group I and Group II, the degree of vision did not differ significantly (p>0.05). In group I and group II, the examination findings were not significant (p>0.05). In group I and group II, recovery time was significantly different (p

Comparison of anterior segment optical coherence tomography findings in acanthamoeba keratitis and herpetic epithelial keratitis.

This study is to investigate the characteristic features of Acanthamoeba keratitis (AK) that differentiating it from herpetic epithelial keratitis (HEK) using anterior segment optical coherence tomography (AS-OCT). Medical records of three eyes of each AK and herpetic keratitis who had AS-OCT examination were reviewed in this study. Slit-lamp biomicroscopy and AS-OCT was performed on the initial visit and on every follow-up visits in all patients. In all three AK cases, reflective bands in the corneal stroma that correspond to the area of radial keratoneuritis were observed. The depth of the reflective bands varied in each case. After AK treatment, slit-lamp biomicroscopy confirmed that radial keratoneuritis had resolved and AS-OCT confirmed that reflective bands in the corneal stroma had also disappeared in all patients. Unlike the AS-OCT results found in AK, highly reflective HEK lesions were observed only in the subepithelial area, not in the stroma. AS-OCT seems to be helpful analyzing the specific depth of the lesion which enables to distinguish AK from HEK.

Self-Retained Amniotic Membrane Combined With Antiviral Therapy for Herpetic Epithelial Keratitis.

To evaluate the therapeutic benefit of self-retained cryopreserved amniotic membrane in conjunction with oral antiviral therapy in herpetic epithelial keratitis. Retrospective review of 4 patients with primary (1 eye) and recurrent (3 eyes) unilateral herpetic epithelial keratitis treated with cryopreserved amniotic membrane through the placement of the PROKERA Slim (PKS) (Bio-Tissue, Inc) in conjunction with oral acyclovir. Their symptoms, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. Herpetic epithelial keratitis presented as dendritic (3 eyes) and geographic (1 eye) epithelial lesions. After epithelial debridement and placement of the PKS for 5 ± 3.7 days, all patients reported significant relief of symptoms, rapid corneal epithelialization, and reduction of ocular surface inflammation. The visual acuity was also improved in all eyes from 0.7 ± 0.7 to 0.4 ± 0.7 logarithm of the minimum angle of resolution (P = 0.2). They remained symptom-free during a follow-up period of 2.7 to 50.8 (20.3 ± 21.7) months. The PKS in conjunction with oral acyclovir facilitates the ease of early intervention to accelerate restoration of a normal corneal epithelium in herpetic epithelial keratitis.

Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: Short-term complications

To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients. Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey. Nonrandomized retrospective clinical study. Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively. The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P = .001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P = .001). Salzmann-like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P = .567 and P = .479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P = .001). Ocular surface healing disorders were the most common early complications of CXL. Short-term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal. No author has a financial or proprietary interest in any material or method mentioned.

Recurrent Ocular Surface Inflammation Associated With Human Herpesvirus 6 Infection

To report a case of atypical herpes keratitis and bilateral conjunctivitis associated with human herpesvirus 6 (HHV-6). An immunocompetent 34-year-old man was referred for herpetic epithelial keratitis in his left eye, which was non-responsive to topical acyclovir. Biomicroscopy revealed a central dendritic ulcer with a white stromal infiltrate beneath the ulcer. The corneal scraping multiplex polymerase chain reaction (CLART ENTHERPEX, Genomica, Spain) was positive for HHV-6 and negative for herpes simplex virus, varicella zoster virus, cytomegalovirus, and Epstein-Barr virus. An improvement of the keratitis and visual acuity was achieved with topical fluorometholone and systemic valacyclovir. One year later, the patient complained of redness of the eyes. A slit-lamp examination disclosed bilateral follicular conjunctivitis, and HHV-6 DNA was once again detected in a conjunctival scraping of both eyes. Human herpesvirus 6 may be another causative agent for corneal ulcers and conjunctivitis in isolation. Stromal necrosis is a rare manifestation of herpetic dendritic keratitis. In these cases, we should consider the presence of HHV-6 in the differential diagnosis, even in immunocompetent patients.

Effects of antiviral medications on herpetic epithelial keratitis in mice.

Aciclovir (ACV), valaciclovir (VACV) and famciclovir (FCV) are used for systemic infections caused by herpes virus. In Japan, only topical ACV is permitted for use against herpetic keratitis. We investigated the effectiveness of topical ACV, oral VACV and oral FCV on mouse epithelial herpetic keratitis. C57/BL76 mice were inoculated with HSV-1 McKrae strain in the cornea. Once infection was confirmed 4 days after inoculation, topical ACV, oral VACV and FCV were started and administered for 5 days. Control groups were given either topical or oral saline. On days 2, 4, 6 and 10 after medication started, tears, eyeballs, and trigeminal ganglia were examined using viral culture and real-time PCR. Viral culture of tears detected no HSV in the topical ACV group on day 4 after administration start; with similar results for the oral VACV group on day 4; and the oral FCV group on day 6. Real-time PCR of the eyeballs showed significant decrease of HSV DNA copy number in the topical ACV group on days 4 and 6 compared to the topical saline group. Real-time PCR of the trigeminal ganglia showed significant decrease of HSV DNA copy number in the oral VACV group on days 4 and 6, and in the oral FCV group on day 6 compared to the oral saline group. We suggest that 5-day administration of topical ACV, oral VACV and oral FCV are effective for mouse epithelial herpetic keratitis and sufficiently decrease HSV amounts in the ocular surface and eyeballs.

Eficacia del ganciclovir tópico como alternativa terapéutica de la queratitis epitelial herpética

ObjectiveTo compare the healing rate in less than 7 days with the use of ganciclovir or acyclovir in patients with epithelial herpetic keratitis. Materials and methodsWe designed a randomized clinical trial including patients with epithelial herpetic keratitis seen at Centro de Oftalmología de la Fundación Santos y de la Garza Evia. There were 2 treatment groups: 0.15% ganciclovir gel and acyclovir 3% ointment, applied 5 times a day until the dendrite closed, and then 3 times a day for 3 days. We evaluated patients daily until the ulcer healed. A validated symptom scale was provided in each visit. ResultsWe recruited 23 patients: 13 treated with ganciclovir (56.5%) and 10 (43.4%) with acyclovir (P=.94), the mean age was 47.69 years (SD±18.6) for the first group, and 56.8 years (SD±9.6) for the second (P=.17). The initial ulcer size was similar in both groups: 2.3mm (±1.85) in acyclovir and 3.0mm (±0.94) in ganciclovir. On the first day the median ulcer size was 1.5mm acyclovir (IQR=1.8) and ganciclovir 1mm (IQR=1.9) (P=0.257), which does not show a clinically significant difference. At day 7, the ulcer had closed to 0mm (IQR=0) in all cases of ganciclovir compared with acyclovir 1mm (IQR=1.7) (P=.000). ConclusionsThe healing rate of ganciclovir in less than 7 days for EK was superior compared with acyclovir.

130 : Interplay between epigenetic mechanisms and signaling pathways will determine macrophage phenotypes in response to environmental cues

An innate immune response clears herpes simplex virus type 1 (HSV-1) from the corneal epithelium following primary corneal infection. Herpetic epithelial keratitis is the most common form of HSV-1 corneal infection seen in the clinic, and can lead to an inflammatory sequel called herpes stromal keratitis that is the leading infectious cause of blindness in the United States. Interaction of the inhibitory receptor Programmed Death (PD)-1on inflammatory cells with its ligand (PD-L1/B7-H1) dampens adaptive immune responses, but its precise role in innate immune regulation is not fully understood. HSV-1 clearance from infected corneas was significantly enhanced in B7-H1 −/− mice compared to wild type mice as early as 1 day post infection (DPI), prior to the initial involvement of NK cells at 4 dpi. Normal corneas express PD-L1 on epithelial cells, and also possess resident CD45 + cells including dendritic cells and macrophages that might also express PD-L1. Fluorescence confocal microscopy revealed an increased number of infiltrating CD45 + cells, Gr-1 high cells, and CCR2 + cells in the central cornea of B7-H1 −/− mice at 1 DPI, in association with increased expression of the chemokines CCL2 by CD45 + cells in the central cornea, and CXCL2 by CD45 − cells around the viral lesion. Bone marrow chimera mice that expressed PD-L1/B7H1 only on bone marrow derived cells did not exhibit enhanced HSV-1 clearance until 4 DPI, at which time PD-L1 deficiency on parenchymal cells was associated with increased numbers of CD69 + and granzyme B + NK cells in the cornea. We conclude that PD-1 interaction with PD-L1 on hematopoetic cells suppresses effective viral clearance at 1 dpi by inhibiting local chemokine production and leukocytic infiltration, whereas the effect of PD-1 interaction with PD-L1 on non-hematopoetic cells (likely cornea epithelial cells) is delayed until 4 dpi and appears to involve inhibition of NK cell activation.

Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression

PurposeTo report a case of acyclovir-resistant herpetic keratitis in a solid-organ lung transplant recipient that was effectively treated with topical trifluridine.MethodsA case of a 35-year-old female with herpetic epithelial keratitis resistant to acyclovir is described. The patient presented following treatment for 4 weeks with topical acyclovir ointment five times per day and oral valacyclovir 1 g three times per day for herpetic keratitis with no resolution of the epithelial defect or symptoms. Corneal scrapes and swabs were taken for confirmation of the diagnosis and resistance testing. The results were positive for herpes simplex virus 1 and showed acyclovir resistance (inhibitor concentration 90 = 200 μg/mL) and foscarnet sensitivity (inhibitor concentration 90 = 200 μg/mL). The patient was treated with topical trifluridine 2-hourly for 3 weeks and weaned off the drops over the following week.ResultsThe patient showed resolution of the epithelial defect, but did have significant corneal toxicity associated with the use of the trifluridine. At 8 weeks, the patient had some stromal shadowing associated with the recent active infection, but symptoms had settled.ConclusionThis case documents the effective use of topical trifluridine in proven acyclovir-resistant herpetic keratitis. It highlights three things: (1) the importance of considering topical trifluridine as an alternative to topical acyclovir in unresponsive disease; (2) the need to consider solid-organ transplant recipients in the immunocompromised population with resistant herpetic disease, and (3) the need to look for alternatives to treatment of resistant herpetic disease.

Multicentre clinical study of the herpes simplex virus immunochromatographic assay kit for the diagnosis of herpetic epithelial keratitis

Background/aimsThe novel immunochromatographic assay (ICGA) kit was recently developed to diagnose herpes simplex virus (HSV) infection. This multicentre study aimed to evaluate the value of the ICGA kit for the...

Detection of ICP0 protein in tear fluid of individuals with active herpetic epithelial keratitis

Infected cell protein 0 (ICP0) has been detected in the tear fluid of rabbits with herpetic keratitis. Here, we investigated whether ICP0 of herpes simplex virus 1 is detectable in the tear fluid of patients with herpetic epithelial keratitis. Seven patients with herpetic epithelial keratitis (age range, 51-76 years) and 11 healthy volunteers (age range, 48-85 years) were enrolled in the study. Tear fluid was collected with the use of Schirmer test strips and subjected to immunoblot analysis with antibodies to ICP0. ICP0 was not detected in the tear fluid of the healthy controls, whereas it was detected in 4 of the 7 patients with herpetic keratitis. The tear fluid of the 4 ICP0-positive patients was collected within 3 days of the onset of keratitis, whereas that of the ICP0-negative patients was obtained at least 7 days after disease onset. ICP0 was detected in the tear fluid of patients in the early phase of herpetic epithelial keratitis, but not in that of patients in the later stages of the disease nor in that of the healthy controls. ICP0 expression may thus be dependent on the disease phase.

Herpes Keratitis in a Patient Undergoing Treatment With Topical Mitomycin C

To report a case of herpetic keratitis in a patient undergoing mitomycin C therapy for conjunctival squamous cell carcinoma. Case report. A 70-year-old man was referred to the Massachusetts Eye Research and Surgery Institution in consultation for a persistent redness in the right eye. He was diagnosed with conjunctival squamous cell carcinoma and treated with topical mitomycin C (MMC). The patient initially improved on topical MMC therapy. At the end of the second cycle of topical MMC, he complained of intense ocular pain and redness in the eye under treatment. A diagnosis of herpetic epithelial keratitis was made based on the clinical findings, and he was subsequently treated with 1 drop of trifluridine 9 times per day in the affected eye. The patient responded with dramatic improvement and resolution of symptoms. This case reports a reactivation of latent herpes simplex virus with productive ocular infection, triggered by MMC therapy and highlights the importance of awareness of this possible risk associated with the use of MMC.

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Herpetic keratitis: Herpes simplex virus versus host

AbstractHerpes simplex virus type 1 (HSV‐1) is an endemic virus worldwide that causes ocular disease in a limited but significant number of infected persons. Corneal HSV‐1 infection is clinically classified into herpetic epithelial keratitis (HEK) and herpetic stromal keratitis (HSK). HEK is an acute inflammation and results from viral toxicity of infected corneal epithelial cells. In contrast, HSK is characterized as a chronic immunopathogenic disease in which tissue injury and eventually blindness is due to the complex interplay between cells of the innate and adoptive immune response to viral antigens expressed in the corneal tissue. Studies performed on the experimental HSK mouse model greatly improved our understanding of the pathogenesis of HSK. This talk will recapitulate current insights on the virus‐host interactions involved in the initiation and perpetuation of herpetic keratitis in mice and men.