Stromal and endothelial herpes simplex virus keratitis reactivation in the convalescent period of COVID-19 � A case report

A 73?year?old lady presented with a white spot and redness in the left eye for 1 month and had been treated elsewhere as a case of fungal keratitis. She had severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) viral infection 2 months before. Her past ocular history and examination gave a probable diagnosis of herpetic stromal and endothelial keratitis. She responded to oral acyclovir and topical steroid, leading to resolution of stromal edema and inflammation. Anterior chamber fluid polymerase chain reaction (PCR) confirmed pathogen herpes simplex virus (HSV)?1. HSV ocular reactivation after coronavirus disease 2019 (COVID?19) has been reported currently. The present report will add knowledge about this potential opportunistic ophthalmic infection during the recovery phase of COVID?19 disease

Ranibizumab Injection for Corneal Neovascularization Refractory to Bevacizumab Treatment

Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV). However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior. A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections. Six months postoperatively, there was significant regression of the neovascular area and vessel caliber. Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection. The findings may suggest a new prospect in treating corneal NV.

Reactivation of Herpetic Keratitis in a Patient after Using Two Different Prostaglandin Analogues

PURPOSE: To report a case of herpetic keratitis after administration of two different prostaglandin analogues. CASE SUMMARY: A 68-year-old female with a history of herpetic keratitis in her right eye after using latanoprost seven years previous presented with redness, mild ocular pain and tearing in the same eye. She had also been prescribed travoprost eye drops for both eyes for uncontrolled glaucoma one month earlier. The cornea in her right eye showed a dendritic epithelial defect with focal epithelial erosions. Travoprost treatment was discontinued, and the herpetic keratitis recovered completely in ten days with acyclovir ointment and oral agent. No further recurrence was observed in the following six months.

Three Cases of Secondary Fungal Infection in Herpes Simplex Keratitis

PURPOSE: To report several cases of secondary infection by fungus in herpes simplex keratitis. CASE SUMMARY: A retrospective chart review was performed on 3 eyes of 3 patients who were without improvement and diagnosed with fungal keratitis by smear and culture on prior presentation with herpetic keratitis. Two cases were diagnosed with fungal keratitis, based on the results of culture. Fungal keratitis by Candida albicans was improved with antifungal agents, but a case caused by Fusarium species was more aggravated, regardless of antifungal agents. One case was improved by antifungal medications, which was diagnosed with fungal keratitis by the fungal hyphae manifestation on KOH preparation. CONCLUSIONS: Secondary microbial infection should be considered, when the lesion had no improvement with antiviral agents in herpetic keratitis.

Analysis on Inpatients With Infectious Keratitis: Causative Organisms, Clinical Aspects and Risk Factors

PURPOSE: To investigate the epidemiological, microbiological, and clinical characteristics of inpatients with infectious keratitis and also to elucidate risk factors for unimproved visual outcomes. METHODS: We performed a retrospective chart review of 167 eyes in 167 patients with infectious keratitis hospitalized between January 2005 and December 2007 at Yeungnam University Hospital. RESULTS: Keratitis cases were classified into four groups according to etiology: 92 bacterial, 43 herpes virus, 31 fungal, and 1 acanthamoeba. Culture positivity was 44.6% in bacterial keratitis and 22.6% in fungal keratitis, and KOH positivity of fungus was 48.4%. Of all the 55 isolated pathogens, the most commonly isolated microorganisms were S. epidermidis in Gram-positive bacteria, P. aeruginosa in Gram-negative bacteria, and Candida species in fungus. Epidemiologic characteristics such as male gender (59.9%), an age in the seventh decade (24.6%), farming occupation (40.1%), and trauma with vegetable matter (42.5%) were noted. Many fungal and bacterial keratitis cases were characterized by inadequate use of topical steroid when patients initially presented to our clinic. Visual outcomes were poorer in fungal keratitis than they were in other forms of keratitis. CONCLUSIONS: Risk factors for unimproved visual outcomes included an ulcer exceeding 3 mm in size and a fungal source. Therefore, a strong effort should be made to discern a differential diagnosis in infectious keratitis and to determine the appropriate early treatment for a successful treatment outcome.

Analysis on Inpatients With Infectious Keratitis: Causative Organisms, Clinical Aspects and Risk Factors

PURPOSE: To investigate the epidemiological, microbiological, and clinical characteristics of inpatients with infectious keratitis and also to elucidate risk factors for unimproved visual outcomes. METHODS: We performed a retrospective chart review of 167 eyes in 167 patients with infectious keratitis hospitalized between January 2005 and December 2007 at Yeungnam University Hospital. RESULTS: Keratitis cases were classified into four groups according to etiology: 92 bacterial, 43 herpes virus, 31 fungal, and 1 acanthamoeba. Culture positivity was 44.6% in bacterial keratitis and 22.6% in fungal keratitis, and KOH positivity of fungus was 48.4%. Of all the 55 isolated pathogens, the most commonly isolated microorganisms were S. epidermidis in Gram-positive bacteria, P. aeruginosa in Gram-negative bacteria, and Candida species in fungus. Epidemiologic characteristics such as male gender (59.9%), an age in the seventh decade (24.6%), farming occupation (40.1%), and trauma with vegetable matter (42.5%) were noted. Many fungal and bacterial keratitis cases were characterized by inadequate use of topical steroid when patients initially presented to our clinic. Visual outcomes were poorer in fungal keratitis than they were in other forms of keratitis. CONCLUSIONS: Risk factors for unimproved visual outcomes included an ulcer exceeding 3 mm in size and a fungal source. Therefore, a strong effort should be made to discern a differential diagnosis in infectious keratitis and to determine the appropriate early treatment for a successful treatment outcome.

Cases of Amniotic Membrane Transplantation for Herpetic Keratitis

PURPOSE: To investigate the effect of amniotic membrane transplantation (AMT) on recurrent herpetic keratitis with unhealed corneal epithelial erosion. METHODS: We performed AMT on 5 cases of herpetic keratitis from February 2004 to August 2005. We had applied two layers of fresh amniotic membrane over the corneal lesion and anchored by running suture technique with 10-0 nylon. RESULTS: After AMT, visual acuity improved in 5 eyes of 5 herpetic keratitis patients. In all patients the persistent epithelial erosion was healed and pain was subsided after surgery. CONCLUSIONS: The AMT shortened the usage of antiviral agents and antibiotics, increased compliance, and decreased corneal opacity and neovascularization. The AMT is an effective method for managing recurrent herpetic keratitis with unhealed corneal epithelial erosion that are refractory to conventional treatment.

Bilateral Herpetic Keratitis in a Patient with Pemphigus Foliaceus

PURPOSE: To report a case of bilateral herpetic keratitis in a patient during glucocorticoid treatment of pemphigus foliaceus. METHODS: A 71-year-old man presented with pain and epiphora in both eyes for a week. He had a history of pemphigus foliaceus for a 6-month period and was on glucocorticoid treatment. Anterior segment examination showed conjunctival injection and corneal geographic epithelial defects in both eyes. He was diagnosed with herpetic keratitis and was given a topical antiviral ointment. RESULTS: One week after the initial antiviral treatment, the corneal epithelial defect of the right eye had fully improved, whereas the left eye showed increased stromal edema with enlarged epithelial defects. Oral antiviral agents were given with topical broad spectrum antibiotics, and artificial tears added for the left eye. A week later, the stromal edema of the left eye had decreased but the epithelial defect was stationary. Amniotic membrane transplantation was performed on the left eye. The corneal epithelial defects of the left eye healed remarkably. CONCLUSIONS: Herpetic keratitis is, in general, a unilateral disease. Bilateral herpetic keratitis is much rarer, and has been described mostly in patients with an altered immune system. The disease progress is known to be similar in both eyes in most cases of bilateral herpetic keratitis, whereas in this case, the fellow eye showed delayed healing. Amniotic membrane transplantation seems to be an effective treatment modality on persistent epithelial defect due to herpetic keratitis.

The Early Diagnosis of Herpetic Ke ratitis by Polymerase Chain Reaction

We evaluated the efficacy of polymerase chain reaction(PCR)in the early diagnosis of Herpes simplex virus keratitis(HSK). Among 47 patients(47 eyes), 25 patients were clinically herpetic keratitis and the others were other kinds of keratitis clinically. Tear film specimens were taken from 32 eyes and corneal scrapings from 21 eyes with suspicious herpetic keratitis and clinically incongrous with HSK. PCR for tear and corneal scraping was performed with using DNA primer. 67% of corneal scrapings and 19%tear samples of suspicious herpetic keratitis showed PCR positive. Tear samples from keratitis clinically incongruous with HSK were all PCR negative but 40%of corneal scrapings from these patients represented PCR positive. From these results, PCR is a rapid and effective tool for the early diagnosis of herpetic keratitis and especially useful in cases of nonspecific corneal lesion. However, for the accurate diagnosis of HSK, not only PCR results but also patient's history and corneal findings should be well evaluated.

A Case of Conjunctival Squamous Cell Carcinoma Similar with Herpetic Keratitis

PURPOSE: We reported a case of squamous cell carcinoma in a patient with chronic herpetic keratitis treated with Mitomycin C. METHODS: In a patient with 13-year recurrent chronic herpetic keratitis, we diagnosed invasive squamous cell carcinoma in papillary mass with no response of previous treatment by conjunctival biopsy. RESULTS: After surgical removal and chemotherapy of 0.04% topical Mitomycin C, the eye showed histopathological resolution of squamous cell carcinoma.

Clinical Evaluations of Recurrence after Keratoplasty in Herpes Simplex Keratitis

We conducted a retrospective study of 30 penetrating keratoplasties (30 patients) for corneal opacity due to herpes simplex keratitis from Jan. 1980 to Dec. 1989 at St. Mary's Hospital. The follow-up periods ranged from 1.3 years to 11 years (mean; 4.8 years). Overall, 23 out of the 30 transplants (76.7%) remained clear grafted cornea and 18 eyes (60%) achieved good to excellent visual acuities (0.3 or better). Herpes simplex keratitis was inactive at the time of corneal transplantation in 27 eyes (90%) and the recurrent rate after surgery was 18.5%. Patients with active ulceration or perforation, had particularly poor success rates. The overall rate of recurrent herpetic keratitis after transplantation for herpes was 26.6% Preoperative corneal neovascularization was not a statistically significant prognostic factor with regard to final visual outcome, graft clarity, graft rejection or recurrent herpetic keratitis.

Clinical Evaluations of Recurrence after Keratoplasty in Herpes Simplex Keratitis

We conducted a retrospective study of 30 penetrating keratoplasties (30 patients) for corneal opacity due to herpes simplex keratitis from Jan. 1980 to Dec. 1989 at St. Mary's Hospital. The follow-up periods ranged from 1.3 years to 11 years (mean; 4.8 years). Overall, 23 out of the 30 transplants (76.7%) remained clear grafted cornea and 18 eyes (60%) achieved good to excellent visual acuities (0.3 or better). Herpes simplex keratitis was inactive at the time of corneal transplantation in 27 eyes (90%) and the recurrent rate after surgery was 18.5%. Patients with active ulceration or perforation, had particularly poor success rates. The overall rate of recurrent herpetic keratitis after transplantation for herpes was 26.6% Preoperative corneal neovascularization was not a statistically significant prognostic factor with regard to final visual outcome, graft clarity, graft rejection or recurrent herpetic keratitis.