Zoster Keratitis Research Articles

Особенности клинического течения и лечения кератита, вызванного вирусом Varicella Zoster

Особенности клинического течения и лечения кератита, вызванного вирусом Varicella Zoster

Two Patients With the von Szily Reaction: Herpetic Keratitis and Contralateral Retinal Necrosis

To present two patients with prior unilateral, herpetic keratitis who developed acute retinal necrosis (ARN) in the contralateral eye. These cases have noticeable similarities to the von Szily reaction. This describes the development of a contralateral retinitis subsequent to an anterior chamber injection of herpes simplex virus (HSV). Interventional case series. Retrospective chart and literature review. The first patient had neonatally acquired herpetic keratitis and developed ARN at age 21. Polymerase chain reaction of a vitreous biopsy detected HSV type-2 (HSV-2). The second patient was clinically diagnosed with ARN contralateral to varicella zoster keratitis. A detailed literature search located seven prior case reports with a von Szily reaction. These resembled our two cases except none had HSV-2 or years of latency from keratitis to retinitis. Clinicians need to be cognizant of the von Szily reaction.

Prescribing trends in infectious keratitis: a survey of New Zealand ophthalmologists.

To obtain an overview of the treatment of infectious diseases of the cornea by New Zealand ophthalmologists and to analyse the data in the context of evidence-based treatment recommendations. A questionnaire was sent to all New Zealand ophthalmologists. It comprised 23 multiple-choice questions pertaining to the characteristics of the respondents, the nature of their practice and their prescribing preferences in infectious conjunctivitis and keratitis. Of the 93 ophthalmologists surveyed, 80.6% returned the questionnaire. Of those in clinical practice, 91.4% regularly treated patients with corneal disease. A subspecialty interest in cornea was stated by 12.5% of these. This paper reports observations for adenoviral conjunctivitis and adenoviral, Herpes simplex, varicella zoster, bacterial, acanthamoebal and fungal keratitis. In some conditions prescribing practice varied dramatically, such as in adenoviral conjunctivitis where 50% of respondents prescribed a corticosteroid and 51.6% an antibiotic, whereas 37.5% prescribed only lubrication or no topical treatment. In other conditions there was a high degree of agreement between ophthalmologists; indeed, all ophthalmologists treated Herpes simplex dendritic keratitis with topical acyclovir. No statistically significant differences in prescribing habits were identified between subspecialist and non-subspecialist groups, although some important clinical differences emerged. There were occasional marked differences in response when the age group of respondents was considered, particularly in relation to the management of adenoviral infections and bacterial keratitis. The findings of this survey suggest that the majority of New Zealand ophthalmologists generally follow international guidelines for the management of infectious keratitis. The identified variations in management provide a foundation for informed clinical debate and the development of treatment guidelines, in line with evidence-based recommendations.

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.

Detection of varicella-zoster virus DNA in keratectomy specimens by use of the polymerase chain reaction.

To study the correlation of clinical findings, histopathologic features, and detection of varicella-zoster virus (VZV) DNA in keratectomy specimens. Fourteen corneal buttons from patients with a confirmed history of herpes zoster ophthalmicus were examined by use of light microscopy and the polymerase chain reaction. The polymerase chain reaction techniques included gel electrophoresis and hybridization for the detection of VZV DNA. Seven (50%) of the 14 specimens were positive for VZV DNA. The positive findings in the specimens correlated with the clinical findings of uveitis (3/3) and the histopathologic features of chronic stromal keratitis (4/4). Patients with stromal scarring, granulomatous keratitis, and neurotrophic ulcers had negative findings. The largest interval between the initial appearance and detection of viral DNA was 51 years. The results suggest that VZV DNA is not detectable in the cornea in every patient and at every stage of zoster keratitis. This may be due to the low number of VZV particles present in the cornea or the lack of viral DNA in the keratocytes. It remains unclear whether the VZV-related keratopathy is caused by an immunologic response to a viral antigen, the viable virus itself, or both.

Corneal lipofuscinosis--clinicopathologic study of 10 patients

Lipofuscin pigments are considered indigestible residues of lysosomal activity associated with aging. We present the clinical and histopathological features of ten patients with corneal lipofuscinosis. Ten patients (five female, five male, mean age 62 years, range 53 to 77 years) underwent penetrating keratoplasty for vascularized corneal scars. The clinical diagnoses were herpes simplex keratitis (5), zoster keratitis (1), phlyctenular keratitis (1), immunologic graft rejection (2) and corneal injury (1). The mean duration of disease was 6.5 years (range 3 to 11 years). On slit lamp examination both linear and diffuse deposits of yellow pigment were noted in the corneal stroma. All corneal buttons were processed for histopathologic and electron microscopic studies. The areas of yellowish pigmentation in the corneal stroma corresponded histopathologically to clusters of macrophages, keratocytes and occasional giant cells containing PAS-positive granules. The granules measured 1 to 3 micrometers and were also present extracellularly. Results of Gram stain were negative, but the material showed vivid autofluorescence. Corneal lipofuscin can be detected at the slit lamp as focal or diffuse yellowish deposits in both the superficial and deep corneal stroma of patients with long-standing keratitis. This is in contrast to corneal iron deposits, which appear as yellowish pigment in the corneal epithelium. The identification of corneal lipofuscin is possible using histochemical and autofluorescent studies. Further studies should address whether corneal lipofuscin predisposes to suture loosening.

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.

Varicella Disciform Stromal Keratitis

We treated five patients, aged 26, 4, 6, 13, and 7 years, who developed disciform stromal keratitis one, four, four, eight, and ten weeks, respectively, after the onset of the acute vesicular exanthema. Serologic testing confirmed recent varicella and excluded other infectious causes in two cases. After initial improvement with a topical corticosteroid, three patients developed recurrent corneal inflammation resembling zoster keratitis. These cases and previous reports indicate that varicella-zoster virus is a cause of disciform stromal keratitis that may occur and recur several weeks or months after the primary skin rash has resolved.

Late Wound Complications after Circular Keratotomy for Zoster Keratitis

We observed spontaneous melting and separation of circular keratotomy wounds in two zoster patients 8 and 23 years, respectively, after surgery. In one case, it could be demonstrated that the upper part of the unaffected keratotomy wound was formed by a large epithelial plug. It is probable that this type of wound may cause late complications under unfavorable conditions.

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

Electron-microscopic examinations in cases of keratitis dendritica (author's transl)

Scanning electron-microscopic and transmission electron-microscopic examination of cornea affected with herpes simplex (DNS) and which developed the clinical picture of keratitis dendritica, showed typical test results, which are described in detail. The ultramicroscopic findings show that the metabolism of the epithelial cells is of considerable degree. It was proved that there were virus particles in the protoplasm of the epithelial cells. A comparison with a case of zoster keratitis showed the same morphological changes.

Diagnosis and treatment of neuroparalytic zoster keratitis (author's transl)

In severe zoster keratitis many pathogenic factors are involved. In addition to viral manifestations, the cornea is often affected by anterior uveitis or secondary glaucoma. Neuroparalytic keratitis causes lowered blinking frequency and decreased tear secretion. In addition, zoster ulcerations of the upper lid margin mechanically disturb reformation of the tear film and weaken the lipid layer by necrosis of the Meibomian glands. Ointments reduce break-up time and parasympathicolytic mydriatics further decrease tear secretion. When the average time between two blinks is shorter than the tear film break-up time, a "dry eye" condition usually develops. The appropriate treatment in such cases is thorough prevention of evaporation.

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.

Dendritic lesions in herpes zoster ophthalmicus.

Thirteen dendritic corneal lesions have been observed in nine patients suffering from herpes zoster. These lesions appear morphologically distinct from herpes simplex dendrites. Cultures from all lesions were negative for herpes simplex virus, and serum antibodies to herpes simplex were not present in five patients tested. The role of steroids in the treatment of these lesions is discussed with respect to the fact that dendritic lesions do not invariably indicate the presence of herpes simplex virus infection of the cornea in patients with zoster keratitis.

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,