Advances in the diagnosis of herpes simplex stromal necrotising keratitis: A feasibility study on deep learning approach

Purpose: Infectious keratitis, especially viral keratitis (VK), in resource?limited settings, can be a challenge to diagnose and carries a high risk of misdiagnosis contributing to significant ocular morbidity. We aimed to employ and study the application of artificial intelligence?based deep learning (DL) algorithms to diagnose VK. Methods: A single?center retrospective study was conducted in a tertiary care center from January 2017 to December 2019 employing DL algorithm to diagnose VK from slit?lamp (SL) photographs. Three hundred and seven diffusely illuminated SL photographs from 285 eyes with polymerase chain reaction–proven herpes simplex viral stromal necrotizing keratitis (HSVNK) and culture?proven nonviral keratitis (NVK) were included. Patients having only HSV epithelial dendrites, endothelitis, mixed infection, and those with no SL photographs were excluded. DenseNet is a convolutional neural network, and the two main image datasets were divided into two subsets, one for training and the other for testing the algorithm. The performance of DenseNet was also compared with ResNet and Inception. Sensitivity, specificity, receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were calculated. Results: The accuracy of DenseNet on the test dataset was 72%, and it performed better than ResNet and Inception in the given task. The AUC for HSVNK was 0.73 with a sensitivity of 69.6% and specificity of 76.5%. The results were also validated using gradient?weighted class activation mapping (Grad?CAM), which successfully visualized the regions of input, which are significant for accurate predictions from these DL?based models. Conclusion: DL algorithm can be a positive aid to diagnose VK, especially in primary care centers where appropriate laboratory facilities or expert manpower are not available

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

Trasplante de membrana amniótica para el tratamiento de queratitis ulcerativa recurrente por virus herpes simple

La queratitis por herpes simple es una de las causas más importantes de ceguera por infección corneal. El virus permanece latente en el huésped humano después de la infección primaria y puede ser reactivado por muchos factores, como traumatismos, estrés, exposición al sol, procesos que cursen con fiebre asociada, procedimientos quirúrgicos, entre otros. Una vez activado, se traslada a través del nervio trigémino hacia la córnea y causa la infección recurrente, la cual produce cicatrización corneal. Clínicamente, la membrana amniótica usada como sustituto de la membrana basal ha sido aplicada satisfactoriamente para el manejo de defectos epiteliales persistentes con o sin ulceración. Además, se ha descrito que el trasplante de membrana amniótica de múltiples capas es útil para el tratamiento de úlceras corneales profundas, descemetoceles y perforaciones corneales pequeñas. El presente reporte describe un caso de queratitis por herpes simple tratado con membrana amniótica con el que se obtuvo una agudeza visual buena y ausencia de queratitis recurrente durante dos años

Herpes simplex keratitis is one of the leading causes of infectious corneal blindness in the world. It remains latent in the human host after the primary infection and can be reactivated by many factors. When activated, it travels along the trigeminal nerve to the cornea, and causes recurrent infection which leads to corneal scarring. Clinically, preserved AM used as a basement membrane substitute has been applied successfully for the management of persistent epithelial defects with and without ulcerations. Furthermore, multilayered AMT has been described to be useful for the treatment of deep corneal ulcers, descemetoceles, and small corneal perforations. This report describes a case of herpes simplex keratitis treated by amniotic membrane transplantation that resulted in high visual acuity and the absence of keratitis recurrent during two years

Cell culture isolation can miss the laboratory diagnosis of HSV ocular infection / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: We compared polymerase chain reaction (PCR) to cell culture isolation for the laboratory diagnosis of ocular herpes simplex virus (HSV) disease.METHODS: Laboratory and medical records of consecutive patients were reviewed for results of (1) HSV PCR testing, (2) HSV cell culture isolation, and (3) clinical diagnosis. PCR results were statistically compared to cell culture isolation and patients initially diagnosed for ocular HSV infection.RESULTS: Of 581 cases submitted for laboratory testing,520 were PCR negative, cell culture negative (89.6％); 0 was PCR negative, cell culture positive (0％); 27 were PCR positive, cell culture negative (4.6％); and 34 were PCR positive, cell culture positive (5. 8％). PCR tested more positive than cell culture isolation (McNemar's, P=0.0001 ). Of 47 HSV PCR positive cases with complete medical records, 19 were cell culture negative for HSV and 28 were cell culture positive for HSV. Fourteen of 19 cell culture negative cases (74％) (Without PCR, 5 cases of HSV would be missed) and 25 of the 28 cell culture positive cases (89％) ( Laboratory testing was necessary for diagnosing 3 cases) were clinically diagnosed with HSV at the initial examination.CONCLUSION: PCR was a more definitive test for diagnosingHSVocularinfectionthancellculture isolation. Cell culture isolation alone can miss an atypical presentation of HSV ocular infection.