INTRODUCTION: The human herpes virus is an important source of ophthalmic
morbidity worldwide. Herpes simplex virus however, continues to be
an important cause of unilateral corneal blindness worldwide. It is a
multifaceted disease capable of inducing the most baffling problems
through both infectious and immune mechanisms. Despite considerable
progress in understanding the virus at cellular and molecular levels the
prospect of prevention still appears to be a long way off.
AIM OF THE STUDY:
The main objective of the study is
To study the clinical pattern
To assess the disease free intervals
To assess the visual outcome
Of recurrent herpes simplex keratitis in Government Rajaji
Hospital β Madurai.
MATERIALS AND METHODS: 46 patients were examined over a period of 1 year at the cornea
services Government Rajaji Hospital β Madurai
All patients with a clinically documented recurrent herpes
simplex infection who were treated in our hospital were included in the
study.
They were analysed retrospectively using a standardized
questionnaire which assessed the age, sex, clinical type of previous
herpes simplex virus corneal disease, duration of disease free interval,
trigger factors if any, laterality of the disease.
A detailed slit lamp examination was done and the clinical type of
herpes simplex keratitis was assessed. A diagnosis of epithelial keratitis was made when a branching
linear dendritic ulcer or a geographic ulcer appearing as a broad area of
epithelial defect with amoeboid borders was seen.
Stromal keratitis was diagnosed when deeper layers of corneal
stroma showed diffuse infiltration and odema of the stroma with or
without necrosis, ulceration and vascularization. Necrotizing keratitis,
interstitial keratitis, immune ring, limbal vasculitis, disciform keratitis
are included in this.
Keratouveitis was diagnosed when there was a severe corneal
odema with or without vascularization and marked signs of anterior
uveitis. Since it was difficult to differentiate clinically mild keratouveitis
and endothelitis, both were clubbed together for the pattern of analysis
of recurrences.
Neurotropic ulcer was diagnosed when the patients presented
with persistent epithelial defect with grey thickened elevated borders.
The uniform treatment policy was adopted. Epithelial keratitis
was treated with topical 3%acyclovir ointment 5 times a day for 2-3
weeks and topical ciprofloxin eye drops BD.
Stromal keratitis was treated with topical prednisolone acetate in
dosage according to the disease severity along with prophylactic 3%
Acyclovir ointment BD and prophylactic ciprofloxin drops BD along
with homatropine eye drops BD.
Iridocyclitis was treated in the same way as stromal keratitis.
Secondary glaucoma was treated with 0.5% timolol eye drops BD.
When the patient has a combined pattern of epithelial & Stromal
keratitis he was initially treated with topical 3% acyclovir ointment,
homatropine eye drops BD and ciprofloxin eye drops BD until the
epithelium starts healing and then was started on prenisolole acetate
drops.
These patients were followed up for one year using slit lamp
examinations at 3 specified follow up visits during the one year and at
additional times when the patient developed new ocular complaints.
Of the 46 patients 12 patients lost follow up and were excluded
from the study.
The pattern of recurrence was studied for epithelial and stromal
keratitis.
The average disease free interval was calculated for epithelial and
stromal keratitis taking into account only those eyes which recurred
purely in the same pattern as its initial presentation.
CONCLUSION: Herpes simplex eye infection is an important cause of corneal
blindness. Recurrences of the disease are the major cause of ocular
morbidity.
It is being seen from the study that herpes simplex disease often
recurs in the same clinical pattern as the first episode. It is also seen that
stromal involvement though accounting for only about 30% of the initial
presentation, it is the one which shows more number of recurrence at a
shorter interval of time than that of epithelial involvement. Thus stromal
keratitis accounts for the major cause of ocular morbidity due to herpes
simplex keratitis. Hence an early recognition and prompt treatment is
necessary and more light is to be shown on the ways of preventing
recurrences through subsequent studies