Herpes Zoster Keratitis Research Articles

Bilateral Pattern Electroretinogram Abnormalities in Patients with Herpes Zoster Keratitis and Conjunctivitis.

Herpes zoster ophthalmicus (HZO) results from the reactivation of varicella zoster virus (VZV) in the ophthalmic branch of the trigeminal nerve. The inflammation caused by VZV involves multiple tissues in the eyes. Our goal is to evaluate pattern electroretinogram (PERG) changes and their relationship with corneal sub-basal nerve changes in patients with HZO. Twenty-two patients with herpes zoster keratitis or conjunctivitis and 20 healthy volunteers were recruited for this cross-sectional study. A PERG test was performed on both eyes of HZO patients and one eye of the healthy controls. In vivo confocal microscopy (IVCM) was also performed on both eyes of the HZO patients to detect corneal nerve damage. Our results showed changes in the PERG parameters in both eyes of HZO patients compared to the healthy controls. Affected eyes showed delayed N95 peak time and decreased P50 and N95 amplitude compared to the unaffected eyes (p < 0.05, respectively). Both affected and unaffected eyes in HZO patients showed delayed P50 peak time and decreased N95 amplitude (p < 0.05, respectively) compared to controls. In HZO patients, no significant differences in each PERG parameter were found between eyes with and without corneal lesions or between eyes with and without increased Langham's cells in the corneal epithelial sub-basal layer. The IVCM images showed decreased total nerve length and number at the sub-basal layer of the epithelial cornea in affected eyes compared to unaffected eyes (p < 0.05). No significant correlation was found between total nerve length and PERG changes. Our results showed that VZV-affected eyes without central cornea involvement displayed reduced N95 amplitude and prolonged P50 peak time in bilateral eyes compared to the healthy controls. Larger studies are needed to further explore the effect of HZO on the electrophysiological response of the eye and the posterior segment.

Investigation of Altered Spontaneous Brain Activity Patterns in Herpes Zoster Keratitis Using the Percent Amplitude of Fluctuation Method: A Resting-State Functional Magnetic Resonance Imaging Study.

The purpose of this study was to use the percent amplitude of fluctuation (PerAF) to study the changes in brain activity and nerve function of herpes zoster keratitis (HZK) patients. We recruited 20 HZK patients and 20 healthy controls (HCs). Each of these groups included ten males and ten females and were matched in weight and age. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI). The percent amplitude of fluctuation (PerAF) method was used for analysis and detected differences between the two groups in the neurological function of brain areas. We also applied the receiver operating characteristic (ROC) curve to analyze the two groups and did a correlation analysis between the PerAF value, anxiety and depression score, and visual acuity. The PerAF signal at the right putamen and right precentral gyrus was significantly higher in patients than in HCs. However, the PerAF value of the left inferior temporal was lower in patients than in HCs. In addition, the HZK patients' anxiety and depression score (HADS) and visual acuity (V.A.) Log MAR negatively correlated with the PerAF value at the left inferior temporal gyrus. HZK patients had some changes in brain regions, and the changes were also related to their mood and visual acuity. These findings might contribute to other studies on the potential pathological mechanism, disease development, prognosis, and brain function in HZK patients.

Lipid Keratopathy: Histopathology, Major Differential Diagnoses and The Importance of Clinical Correlation.

Lipid keratopathy (LK) is a rare ophthalmological condition characterized by a progressive reduction in visual acuity caused by corneal opacification due to central lipid accumulation. LK is characterized by lipid deposits, cholesterol clefts, and neovascularization (NV) leading to disruption in corneal optical quality. LK classification includes a primary and secondary form which depend on pre-existing corneal or systemic disorders and the evidence of NV. Secondary LK is typically associated with a prior occurrence of herpetic infection, such as herpes zoster keratitis. Patients with LK usually present with progressive vision loss and dense cream-colored corneal opacification. Treatment modalities include conservative and surgical approaches focused on corneal NV elimination. When evaluating corneal lipidosis, it is crucial to consider a range of differential diagnoses, including corneal arcus, Schnyder corneal dystrophy, and other corneal deposit conditions. We report a case of a 62-year-old male with herpes zoster keratitis complicated with LK. He presented with painless progressive vision loss and corneal scarring, which raised suspicion about LK diagnosis. This paper emphasizes the importance of correlating clinical and histological findings for accurate LK diagnosis.

Bilateral Simultaneous Penetrating Keratoplasty: A 40-Year Odyssey

Purpose: The purpose of this study was to report 40-year follow-up on a case of bilateral simultaneous penetrating keratoplasty (PK) involving a contralateral autograft. Methods: This was a case report. Results: A 39-year-old man developed right corneal scarring and lipid keratopathy from previous herpes zoster keratouveitis with visual acuity of 20/200. The left eye had dense amblyopia with visual acuity of 20/300. In 1980, he underwent right PK using a contralateral autograft and simultaneous left PK with an allograft. The right autograft provided excellent visual acuity until the graft failed 40 years later. The left allograft underwent severe endothelial graft rejection 2 months after surgery with gradual corneal clearance over the next 21 months. The left allograft remained clear through 40 years without graft failure. Conclusions: Long-term useful vision and graft survival were achieved with a penetrating autograft by avoiding endothelial graft rejection in the setting of previous herpes zoster keratitis and the patient being functionally monocular. Despite almost failing from severe endothelial graft rejection in the absence of ocular risk factors, the left allograft recovered and remained clear through 40 years possibly because peripheral host endothelial cells repopulated the donor.

Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery

Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO.An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019.There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis.Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Comparing ProKera With Amniotic Membrane Transplantation: Indications, Outcomes, and Costs.

The aim of this study was to compare the outcomes of ProKera versus amniotic membrane transplantation (AMT) in managing ocular surface disease. This study is a retrospective case series of patients who received either ProKera or sutured AMT for ocular surface disease. Patient demographics, treatment indications, retention time, percentage healed area, changes in visual acuity, and costs to the health care system were analyzed. Fourteen patients were identified and analyzed for each group. The main indications for using ProKera and AMT were similar, including corneal ulcer or epithelial defect due to chemical burns, neurotropic state, or herpes zoster keratitis. The average time to dissolution or removal was 24.8 days in the ProKera group, compared with 50.1 days in the AMT group. The average percentage of healed corneal area was 59% for ProKera and 73% for AMT. There was no significant difference between the initial and the final visual acuity within groups and when comparing both groups. In our expense analysis, ProKera had a total cost of 699.00 Canadian dollars (CAD), whereas the cost of suture AMT was 1561.52 CAD. ProKera priced at 11.85 CAD for each percentage healed surface area and at 21.39 CAD for AMT. ProKera allowed for a faster corneal healing than sutured AMT, although its total healed area was less than the latter. Moreover, ProKera is more cost-effective than AMT, thus reducing financial burden to our health care system.

A Review of Treatment for Herpes Zoster Keratitis

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Limbal Stem Cell Deficiency Associated With Herpes Keratitis.

To describe the demographic features and clinical characteristics of patients with herpes keratitis (HK) and limbal stem cell deficiency (LSCD) and identify possible factors associated with development of LSCD after HK. In this retrospective case-series study, records of patients with a clinical diagnosis of HK seen at Massachusetts Eye and Ear over a 5-year period were reviewed for evidence of LSCD. Patient demographics, medical history, treatment, and best-corrected visual acuities (BCVAs) were recorded. We identified 626 patients with HK. Fifty-seven had been diagnosed with LSCD (9.3%). Thirteen percent of patients with herpes zoster keratitis (N= 25) and 7% of patients with herpes simplex keratitis (N= 32) had LSCD (P = 0.01). Keratitis caused by herpes zoster virus [odds ratios (OR), 1.77; 95% confidence interval (CI), 0.97-3.19; P = 0.01], stromal involvement (OR, 2.28; 95% CI, 1.27-4.18; P = 0.02), and the use of topical antihypertensives (OR, 2.28; 95% CI, 1.27-4.18; P = 0.02) were found to be associated with a higher likelihood of developing LSCD. The final logarithm of the minimum angle of resolution (LogMAR) BCVA was significantly lower in patients with LSCD compared with those without LSCD with a mean BCVA of 1.34 ± 1.52 LogMar (∼20/200) as compared to 0.18 ± 0.54 LogMar (∼20/30 ± 20/60) in those patients without LSCD (P = 0.005). Our data suggest that HK may be a risk factor for development of LSCD. Patients with HK should be monitored for the development of LSCD to reduce the risk of chronic ocular surface morbidity.

Management of Corneal Scarring Secondary to Herpes Zoster Keratitis.

To review the management of visually significant corneal scarring secondary to herpes zoster keratitis (HZK). Literature review. Management options for visually significant corneal scarring secondary to HZK include scleral contact lenses, photorefractive or phototherapeutic keratectomy, lamellar keratoplasty, penetrating keratoplasty, and keratoprosthesis. Many authors recommend tarsorrhaphy in at-risk patients at the time of corneal transplantation. Most published studies either did not mention or did not use systemic antivirals at the time of surgery. Longer quiescent periods before surgical intervention may be associated with increased rates of graft survival. Reports of HZK recurrence after live-attenuated vaccine administration suggest that risks and benefits of the vaccine should be carefully considered. Overall, the prognosis of surgical intervention for corneal scarring due to HZK relies on appropriate patient selection and measures to ensure ocular surface stability. There remains a serious risk of ocular surface instability and corneal melt in these patients. Unfortunately, there is a lack of prospective studies in this area to guide clinical management. Patients with visually significant corneal scarring secondary to HZK may have good outcomes with the appropriate medical and surgical considerations, particularly in the absence of active ocular surface disease and inflammation. Those with active disease may benefit from delaying surgical intervention until a satisfactory quiescent period has been achieved. Prospective studies, such as the proposed Zoster Eye Disease Study, are imperative for validating these principles and determining evidence-based management guidelines.

Особенности клинического течения и лечения кератита, вызванного вирусом Varicella Zoster

Особенности клинического течения и лечения кератита, вызванного вирусом Varicella Zoster

Progressive outer retinal necrosis and acute retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome

PURPOSE: To describe an unusual concurrence of acute retinal necrosis and progressive outer retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome (AIDS). METHODS: Interventional case report. In a 37-year-old man with AIDS and herpes zoster keratitis in the right eye, progressive outer retinal necrosis developed in the right eye and acute retinal necrosis developed in the left eye. RESULTS: Disparate presentations of retinitis persisted in each eye, and retinal detachment and vision loss ensued in both eyes despite antiviral therapy. CONCLUSION: Distinct features of acute retinal necrosis and progressive outer retinal necrosis do not necessarily reflect systemic factors, and they may be variant manifestations of the same underlying infection.

Morphology of epithelial keratitis in herpes zoster ophthalmicus

To investigate the in vivo morphology of epithelial changes in acute herpes zoster keratitis. 10 patients with acute disease. In 7, systemic acyclovir treatment was started at presentation, in 2 < or = 24 hours before, 1 was not treated. The corneae were examined with the slit lamp, followed intermittently for 3-30 days, and photographed at intervals ranging between 1 to 7 days. All but one patient had epithelial changes at presentation; all developed new ones. The smallest discernible entities were abnormal cells of about 10-15 microm in diameter, singular or grouped. Larger foci measured about 100-200 microm. 2 patients showed pseudodendrites at presentation, and further 3/9 observed > or = 2 weeks developed them. Some lesions showed white surface plaques. No ulcerations were observed. Healing occurred < or = 10-22 days after the onset of symptoms. The study seemed to have followed the natural course of the disease. The rapidly changing morphology in the absence of ulcerative features indicated successive damage counteracted by reparative forces.

Ocular Manifestations of Human Immunodeficiency Virus

A knowledge of the ocular manifestations of the human immunodeficiency virus (HIV) is becoming increasingly important as the number of patients infected with HIV increases. The ophthalmologist plays an important role in making life-and sight-saving diagnoses. This is becoming more paramount as the life expectancy is prolonged and quality of life is improved with advancements in medical therapy. Many of the diseases discussed in this article are altered manifestations of diseases seen in immunocompetent persons: Kaposi's sarcoma; molluscum contagiosum; herpes simplex and herpes zoster keratitis; syphilis; toxoplasmosis; and acute retinal necrosis. Other diseases that present in the posterior segment are solely seen in immunocompromised patients: cytomegalovirus retinitis; Pneumocystis carinii choroidopathy; and progressive outer retinal necrosis. This article discusses diagnostic and clinical features of these and other diseases seen in patients infected with HIV.

Blinking and Blepharospasm-Reply

In Reply.— We thank Dr Lamberts for his thoughtful comments. In our article, Blinking and Blepharospasm, we concentrated on the mechanisms, diagnosis, and treatment of common neurological and ophthalmologic conditions that cause increased blinking and blepharospasm. Defective tearing is certainly one of the most important ocular disorders, causing eye irritation, increased blinking, and even blepharospasm. We agree with Dr Lamberts that the protective value of proper lacrimation in the normal maintenance of corneal epithelium cannot be overemphasized. Normal reflex tearing may be disturbed by local corneal disease (eg, herpes zoster keratitis), by a lesion in the pontine tegmentum, where the preganglionic sympathetic fibers arise, in the sensory root (nervus intermedius) of the facial nerve, in the greater superficial petrosal nerve or in the deep petrosal nerve, in the sphenopalatine ganglion (eg, nasopharyngeal tumors), and in the ophthalmic or maxillary branches of the trigeminal nerve. An interruption of the afferent or

Historical observations on herpetic keratitis

The history of herpetic keratitis is presented. The similarities and differences between dendritic keratitis and herpes labialis are enumerated, with the suggestion that the similarities (in onset, pathology, and clinical course) far outweigh the differences. The principal difference seems to be that the avascularity of the cornea retards the immunologic responses. Important points in the history of herpetic keratitis include (1) the close association of herpetic disease with malaria around the turn of the century; (2) the relatively benign nature of the disease, in contrast to herpes zoster keratitis; (3) the unfavorable response of the disease to immunosuppressive measures and diseases; (4) the failure of chemotherapy to influence favorably the natural history of the disease; and (5) the increasing visual damage caused by the disease since 1952 when corticosteroids were introduced into ocular therapy. Mention is made of the increasing problem of venereal herpes, with the resultant neonatal herpetic keratitis, retinitis, and encephalitis.

Corticosteroid Therapy in Central Stromal Keratitis

Use of adrenal corticosteroids in central corneal inflammatory disease has been heat­ edly discussed during the past 15 years. Kaufman and Thomas have recom­ mended topical corticosteroid therapy (com­ bined with IUDR) for disciform lesions in herpetic keratitis, while Thygeson has cau­ tioned that they may encourage virus prolif­ eration and lead to catastrophic events. Theo­ dore believes that some cases of deep stromal herpes cannot be controlled without corti­ costeroids. DeVoe has emphasized that corticosteroid therapy in herpes simplex kera­ titis should not be condemned on the basis of rabbit experiments. Corticosteroids may be used guard­ edly' in herpes zoster keratitis; they probably should be avoided in central bacterial ulcers. However, corticosteroids are the treatment of choice' in allergic cor­ neal disease. The general consensus indicates that the use of corticosteroids depends upon the etiologic agent involved rather than the degree of structural alteration. Specific therapy is always preferable but, when it is not successful, nonspecific (corticosteroid) therapy may be used. Following extensive experimental evalua­ tion of the mechanisms of inflammatory reac­ tivity in the rabbit and guinea pig cornea,