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Herpes simplex virus (HSV) is one of the most common etiologic agents of corneal disease and a significant cause of corneal blindness worldwide. Although most cases can be successfully managed with medical therapy, HSV keratitis associated with visually significant stromal scarring often requires corneal transplantation for visual rehabilitation. While penetrating keratoplasty (PK) represented the traditional keratoplasty technique, the past few decades have seen a shift towards lamellar keratoplasty procedures, including deep anterior lamellar keratoplasty and mushroom keratoplasty. This paper describes the current surgical techniques and perioperative antiviral prophylaxis regimen for herpetic keratitis and reviews their postoperative clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: to research the results of PRP-therapy in the treatment of herpetic keratitis (HK). Materials and methods. We research the results of PRP-therapy in the treatment of herpetic keratitis in 16 patients(23 eyes). The patients were divided into 2 groups. In the first group (11 children, 16 eyes - 70%), patients received standard HK treatment, patients of the second group (5 children, 7 eyes - 30%) also received PRP-therapy. Results. In the 2-nd group of children faster and more stable results were obtained compared to patients of the 1st group. The average index of corneal damage at admission in patients, received standard HK treatment, averaged 14.7. In children, received PRP-therapy, it was 15.3, respectively. On the 5th day after the start of treatment, the average corneal lesion index was 8.2 in the first group and 5.9 in the second. On the 10th day after the start of treatment, the corneal lesion index decreased to 6.3 in the first group and 3.1 in the second. When the damaged surface was stained with fluorescein on the 15th day of therapy in 6 eyes (37.5%) of the 1st group and in 5 eyes (71.4%) of the 2nd group, complete epithelialization was observed, the lesion index was 1.2 in patients of group 1 and 0.8 in children of group 2. Conclusion. Using of PRP-therapy in the herpetic keratitis treatment allows to get faster and more stable results than in patients receiving standard treatment. This method is safely, without toxic reactions and local allergic complications and could be recommended in the treatment of herpetic keratitis in children. [ABSTRACT FROM AUTHOR]

The outcomes and complications of the coronavirus infection are of interest to specialists in many fields of medicine, including ophthalmologists.Purpose: to analyze the clinical features of ophthalmic complications in patients with coronavirus infection COVID-19.Materials and methods. Four patients aged 37 to 70 years with ophthalmic inflammatory complications with coronavirus infection were examined and treated.Results. In 2 cases, eye damage was observed in the acute phase of COVID infection. It included deep keratitis, iridocyclitis, and exacerbation of rhinosinusitis complicated by osteomyelitis, orbital phlegmon with loss of vision. In the remaining 2 cases, in the post-COVID period (2 and 5 months after the disease, respectively), acute dacryoadenitis with the dry eye syndrome and subacute episcleritis was observed. In addition to anti-COVID therapy, all patients underwent specific ophthalmic therapy, which in 1 case included surgical intervention.Conclusion. The cases presented demonstrate eye damage against the background of coronavirus infection with the involvement of various eye structures into the inflammatory process. The ophthalmological manifestations were severe, with complications in the acute phase of COVID and in the early post-COVID period. Clinical observations indicate the need for additional specific therapy of coronavirus infection complications, along with the basic anti-COVID treatment.

Background: Herpetic stromal keratitis (HSK) is an immunomodulatory disease that develops as a result of herpes simplex virus (HSV)1 or HSV2 reactivation. HSK is the most common form (20-50%) of recurrent herpetic keratitis (HK) that most commonly results in significantly reduced vision. It is well known that changes in biological compound levels in tear fluid can be indicative of the state of the ocular surface and determine whether ocular surface pathology is present, and, therefore, can be used as diagnostic markers of pathological changes in the ocular surface. Lactoferrin (LF) is one of these compounds and has been proven to have innate antibacterial, antifungal, antiviral, antiparasite, anti-inflammatory, immunomodulatory, antioxidative and other properties. Purpose: To determine tear Lf concentration in patients with recurrent acute HSK, its effect on functional characteristics of the ocular surface, and the therapeutic effect of Lacto eyedrops in the comprehensive treatment for this disorder. Material and Methods: The study was conducted at the site of Corneal Pathology Department and Immunology Laboratory of the Institute in January to December 2021. Seventeen patients (17 affected eyes and 17 fellow eyes) with recurrent acute HSK were included in the study. Mean patient age plus or minus standard deviation (SD) was 48.7 ± 16.0 years. The ophthalmological examination included biomicroscopy of the bulbar conjunctiva and cornea, fluorescein test, determination of corneal sensation and basal tear production (Schirmer’s II test), and microbiological examination of the conjunctiva. Tear Lf concentration was determined by a human Lf enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Inc., Wuhan, China). The results were photometrically measured at 450 nm with an ELISA reader (Stat Fax 2100, Awareness Technology Inc, Palm City, FL). Lacto eyedrops were administered two times a day for 30 days. Tear Lf concentrations were determined at baseline and at day 30. Results: Mean tear LF concentration plus or minus SD in eyes of patients with recurrent HSK was 1.21 ± 0.52 g/l, with no significant difference between the affected eye and fellow eye. However, a subnormal tear LF concentration was more common in the affected eye than in the fellow eye (χ2 = 4.24, р = 0.04). After a 30-day anti-inflammatory treatment with Lacto eyedrops, mean tear LF concentration plus or minus SD increased by 47% to 1.78 ± 0.7 g/l in the affected eyes. A corneal sensation score of 1 to 9 was 12.4 times more common in HSK eyes than in fellow eyes (OR = 12.4; 95% CI, 2.0–76.8), which reflects neurosensory abnormalities in the affected eye. Corneal sensation loss, was, however, more common in HSK eyes with a low tear Lf concentration than in fellow eyes with a low tear Lf concentration. Median basal tear production (as assessed by Schirmer’s II test) was as low as 7-8 mm in eyes with a low tear Lf concentration and as high as 13-16 mm in eyes with a high tear Lf concentration (p < 0.05). There was a direct correlation between the basal tear production and the tear Lf concentration (r=0.45; p < 0.05). Among study patients with recurrent HSK, 24.9% showed baseline microbiological evidence of potentially pathogenic or fungal organisms in the conjunctiva. A course of multicomponent anti-inflammatory treatment with Lacto eyedrops contributed to complete removal of these organisms. Conclusion: We determined mean tear Lf concentrations in affected and fellow eyes of patients with recurrent HSK, and established certain relationships between functional characteristics of the ocular surface and tear Lf concentrations in these eyes. A disinfecting effect of Lacto eyedrops against any microorganisms present in the conjunctival sac of patients with recurrent HSK was confirmed by the absence of culture growth on completion of the multicomponent anti-inflammatory treatment.

Herpes simplex virus (HSV) is one of the most common etiologic agents of corneal disease and a significant cause of corneal blindness worldwide. Although most cases can be successfully managed with medical therapy, HSV keratitis associated with visually significant stromal scarring often requires corneal transplantation for visual rehabilitation. While penetrating keratoplasty (PK) represented the traditional keratoplasty technique, the past few decades have seen a shift towards lamellar keratoplasty procedures, including deep anterior lamellar keratoplasty and mushroom keratoplasty. This paper describes the current surgical techniques and perioperative antiviral prophylaxis regimen for herpetic keratitis and reviews their postoperative clinical outcomes.

Purpose: to assess the effectiveness of the combined interferon alpha-2b-based medicine (Ophtalmoferon, eye drops) in the complex treatment of herpetic keratitis in patients who had coronavirus infection caused by SARS-CoV-2.Materials and methods. The study group included 53 people aged 18 to 74 years (mean age 46.0 ± 7.8 years) with the following complaints: decreased vision, redness, eye pain, lacrimation, photophobia and foreign body sensation under the eyelid. Criteria for selection and inclusion of patients were: typical for herpetic keratitis corneal infiltrates detected by biomicroscopy; herpetic infection detected by Polymerase Chain Reaction (PCR) in the affected eye corneal scrape; a medical history of the novel coronavirus infection confirmed by PCR. The patients were divided into two groups. Group 1 (n = 32) received complex treatment with the combined interferon alpha-2b-based medicine (Ophtalmoferon®, eye drops) at early stages of the disease (from the 1st to 7th day after the first complaints). Group 2 (n = 21) received complex treatment with Ophtalmoferon® at later stages (from the 14th day of the first complaints). The effectiveness and tolerability of Ophtalmoferon were assessed during the dynamic monitoring of the patients.Results. A positive trend was noted in 79.2 % (n = 42) of all patients who received Ophtalmoferon for the complex treatment of herpetic keratitis: a gradual improvement in visual acuity, reduction or disappearance of photophobia, lacrimation and eye pain. In 20.8 % (n = 11) of all cases, mostly related to the late start of etiological therapy, the treatment effectiveness was lower, the disease lasted longer and was accompanied by the involvement of the choroid, the development of more severe opacities in the place of corneal infiltrates. Due to later start of etiotropic therapy the inflammatory process affected deeper layers of the cornea up to the development of corneal ulcer with perforation, which required surgical intervention.Conclusion. The etiotropic treatment of herpetic keratitis in patients after COVID-19, if started in the first days of the disease, can quickly stop the inflammatory process and prevent its spread to deeper layers of the cornea. Ophtalmoferon is a highly effective medicine for etiotropic treatment of keratitis caused by herpesviruses. Due to high patient compliance, Ophtalmoferon can be recommended for wide use in the complex therapy of herpetic keratitis.

Background: Herpetic stromal keratitis (HSK) is an immunomodulatory disease that develops as a result of herpes simplex virus (HSV)1 or HSV2 reactivation. HSK is the most common form (20-50%) of recurrent herpetic keratitis (HK) that most commonly results in significantly reduced vision. It is well known that changes in biological compound levels in tear fluid can be indicative of the state of the ocular surface and determine whether ocular surface pathology is present, and, therefore, can be used as diagnostic markers of pathological changes in the ocular surface. Lactoferrin (LF) is one of these compounds and has been proven to have innate antibacterial, antifungal, antiviral, antiparasite, anti-inflammatory, immunomodulatory, antioxidative and other properties. Purpose: To determine tear Lf concentration in patients with recurrent acute HSK, its effect on functional characteristics of the ocular surface, and the therapeutic effect of Lacto eyedrops in the comprehensive treatment for this disorder. Material and Methods: The study was conducted at the site of Corneal Pathology Department and Immunology Laboratory of the Institute in January to December 2021. Seventeen patients (17 affected eyes and 17 fellow eyes) with recurrent acute HSK were included in the study. Mean patient age plus or minus standard deviation (SD) was 48.7 ± 16.0 years. The ophthalmological examination included biomicroscopy of the bulbar conjunctiva and cornea, fluorescein test, determination of corneal sensation and basal tear production (Schirmer's II test), and microbiological examination of the conjunctiva. Tear Lf concentration was determined by a human Lf enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Inc., Wuhan, China). The results were photometrically measured at 450 nm with an ELISA reader (Stat Fax 2100, Awareness Technology Inc, Palm City, FL). Lacto eyedrops were administered two times a day for 30 days. Tear Lf concentrations were determined at baseline and at day 30. Results: Mean tear LF concentration plus or minus SD in eyes of patients with recurrent HSK was 1.21 ± 0.52 g/l, with no significant difference between the affected eye and fellow eye. However, a subnormal tear LF concentration was more common in the affected eye than in the fellow eye (X² = 4.24, p = 0.04). After a 30-day anti-inflammatory treatment with Lacto eyedrops, mean tear LF concentration plus or minus SD increased by 47% to 1.78 ± 0.7 g/l in the affected eyes. A corneal sensation score of 1 to 9 was 12.4 times more common in HSK eyes than in fellow eyes (OR = 12.4; 95% CI, 2.0-76.8), which reflects neurosensory abnormalities in the affected eye. Corneal sensation loss, was, however, more common in HSK eyes with a low tear Lf concentration than in fellow eyes with a low tear Lf concentration. Median basal tear production (as assessed by Schirmer's II test) was as low as 7-8 mm in eyes with a low tear Lf concentration and as high as 13-16 mm in eyes with a high tear Lf concentration (p < 0.05). There was a direct correlation between the basal tear production and the tear Lf concentration (r=0.45; p < 0.05). Among study patients with recurrent HSK, 24.9% showed baseline microbiological evidence of potentially pathogenic or fungal organisms in the conjunctiva. A course of multicomponent anti-inflammatory treatment with Lacto eyedrops contributed to complete removal of these organisms. Conclusion: We determined mean tear Lf concentrations in affected and fellow eyes of patients with recurrent HSK, and established certain relationships between functional characteristics of the ocular surface and tear Lf concentrations in these eyes. A disinfecting effect of Lacto eyedrops against any microorganisms present in the conjunctival sac of patients with recurrent HSK was confirmed by the absence of culture growth on completion of the multicomponent anti-inflammatory treatment. [ABSTRACT FROM AUTHOR]

Purpose: To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis. Methods: In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016–2020) reported to a tertiary care center, which were presumed to be infectious keratitis on the basis of clinical history and presentation. Results: A total of 121 cases with culture-negative keratitis were included in this study. The mean age of the patients was 48.42 ± 1.89 years, and 53.72% were female. At presentation, the presumed etiology was viral in 38.01%, bacterial in 27.27%, fungal in 8.26%, Acanthamoeba in 6.61%, and unlisted in 28.92% of cases. The most common risk factors were a previous history of ocular surface diseases (96.69%) and contact lens use (37.19%). In total, 61.98% of the patients were already on antimicrobial medication at presentation. The initial management was altered in 79 cases (65.29%) during the treatment course. Average presenting and final (post-treatment) visual acuities (VA) were 0.98 ± 0.04 (LogMAR) and 0.42 ± 0.03 (LogMAR), respectively. A significantly higher frequency of patients with a final VA worse than 20/40 (Snellen) had worse VA at initial presentation (p < 0.0001). A history of ocular surface disease, cold sores, and recurrent infection (p < 0.05) were more commonly associated with a presumed diagnosis of viral keratitis. The patients with presumed bacterial etiology were younger and had a history of poor contact lens hygiene (p < 0.05). Conclusions: We observed a distinct difference in clinical features among patients with culture-negative and PCR-negative keratitis managed for presumed viral and bacterial infections. Although there was significant variability in presentation and management duration in this cohort, the visual outcomes were generally favorable. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: to describe the experience of practical solutions for herpetic keratitis of a protracted course with latent chronic sinusitis and tonsillitis.Material and methods. We observed 111 patients with various forms of prolonged herpetic keratitis and inflammatory ENT pathology. All patients underwent a study of biological secretions (tear, saliva, blood and urine) for the presence of DNA of herpetic viruses by PCR, systemic antiviral therapy was prescribed. All patients underwent a standard otorhinolaryngological examination, СТ scan of the paranasal sinuses (if necessary), microbiological study of nasopharynx swabs. Local therapy of herpetic keratitis included anti-inflammatory and antibacterial components.Results and discussion. Isolated sinus inflammation occurred in 59 % of cases (65 patients), in 38 % of cases (42 patients) there were variants of combinations of sinus inflammation (sinusitis, sphenoethmoiditis, pansinusitis). In 24 % of those included in the study (n = 27), during examination, in addition to the presence or absence of sinusitis, chronic tonsillitis was determined. In 30 % of cases (more often than in other secrets), herpetic viruses were detected in saliva, coccal flora dominated in swabs from the nasopharynx. A marked reduction in ophthalmological symptoms correlated with start of ENT therapy.Conclusions. This clinical and laboratory study has showed a close pathogenetic relationship of anterior ophthalmic herpes and concomitant inflammatory pathology of the paranasal sinuses and oropharynx. Active ethiotropic therapy of sinusitis and tonsillitis promotes short-term reduction of ophthalmic symptoms.

Lixiang Wang, Yingping Deng, Ke Ma, Hongbo Yin, Chengshu Sun, Jing Tang Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of ChinaCorrespondence: Jing Tang, Department of Ophthalmology, West China Hospital of Sichuan University, No.37, Guoxue Alley, Sichuan, People’s Republic of China, Tel +86 18980603835, Email tangjing0802@163.comBackground: Corneal crosslinking is widely applied to enhance corneal biomechanical properties and delay the progression of keratoconus. The surgical procedure and application of ultraviolet A irradiation (UVA) during corneal crosslinking have been recognized to induce the reactivation of simplex herpes virus (HSV) but are rarely reported and poorly analyzed.Case Presentation: We report the first case series of herpetic keratitis in 4 keratoconus patients undertaking corneal crosslinking, who were all clinically diagnosed at routine follow-up visits 3 days to 1 month after the surgery. Different from the typical new onset of secondary herpetic keratitis that mainly presents with epithelial lesions and severe eye pain, these patients all presented with stromal infiltrates and were generally asymptomatic except for vision blurring in 2 patients. All patients responded well to antiviral therapy, topical steroids, and epithelial nourishment medication, leaving corneal macula or nebula at the last follow-up visit.Conclusion: Close follow-up is essential and the most effective way to diagnose herpetic keratitis after corneal crosslinking due to the lack of subjective symptoms. The prophylactic use of antiviral therapy on asymptomatic patients is controversial and should be evaluated based on long-term prognosis.Keywords: simplex herpes virus, herpetic keratitis, keratoconus, corneal crosslinking, prophylactic antiviral therapy

Patiens and methods. We observed 111 patients with various forms of prolonged herpetic keratitis and inflammatory ENT pathology. All patients underwent a study of biological secretions (tear, saliva, blood and urine) for the presence of DNA of herpetic viruses by PCR, systemic antiviral therapy was prescribed. All patients underwent a standard otolaryngological examination, СТ scan of the paranasal sinuses (if necessary), microbiological study of nasopharynx swabs. Local therapy of herpetic keratitis included anti-inflammatory and antibacterial components.Results and discussion. Isolated sinus infalanmmation occurred in 59 % of cases (65 patients), in 38 % of cases (42 patients) there were variants of combinations of sinus inflammation (sinusitis, sphenoethmoiditis, pansinusitis). In 24 % of those included in the study (n = 27), during examination, in addition to the presence or absence of sinusitis, chronic tonsillitis was determined. In 30 % of cases (more often than in other secrets), herpetic viruses were detected in saliva, coccal flora dominated in swabs from the nasopharynx. A marked reduction in ophthalmological symptoms correlated with start of ENT therapy.Conclusions. This clinical and laboratory study showed a close pathogenetic relationship of anterior ophthalmic herpes and concomitant inflammatory pathology of the paranasal sinuses and oropharynx. Active etiotropic therapy of sinusitis and tonsillitis promotes short-term reduction of ophthalmic symptoms.

Purpose: Numerous case reports have associated anti-glaucoma medications with recurrence of herpes simplex virus (HSV) and herpes zoster virus (HZV) keratitis. The aim of our study was to determine whether different anti-glaucoma agents are associated with recurrence of herpetic keratitis. Methods: This was a retrospective cohort study using health databases from a Canadian province from January 2001 to December 2012. A new cohort of users on topical prostaglandins (PGs), beta blockers (BBs), alpha-2 agonists (AAs) and carbonic anhydrase inhibitors (CAIs) was created. The date of the third anti-glaucoma drug dispensation within 90 days was deemed the index date of the case. Herpetic keratitis events, as defined by an ICD-9/10 code for HSV or HZV keratitis, or the dispensation of an anti-viral medication by either an ophthalmologist or an optometrist, were examined prior to and following the index date. Risk ratios (RRs) were computed to compare the risk of HSV/HZV keratitis among the PG, BB, AA, and CAI groups individually and collectively while adjusting for age and sex. Results: Among 19,986 users of glaucoma medications identified, there were 684 cases of HSV/HZV keratitis. There was no increased risk of HSV/HZV keratitis recurrence for any of the four glaucoma medications classes individually or collectively when adjusted for age and sex. There was also no increased risk for redeveloping either HSV keratitis only or HZV keratitis only amongst all anti-glaucoma users. Conclusion: There is no association between the use of topical ocular hypotensive therapies and HSV/HZV keratitis recurrence. Further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: Graft failure after penetrating keratoplasty (PK) is a serious complication, especially in eyes with herpetic keratitis (HK). This study evaluated the prevalence and graft survival of herpes simplex virus type 1 (HSV-1) and varicella zoster virus (VZV) DNA in recipient corneas during PK. Methods: The retrospective study was performed at the Department of Ophthalmology at University Hospital in Mainz, Germany. We analyzed data from every patient who underwent PK between January 2020 and June 2021. According to our clinical routine, we performed HSV-1 and VZV polymerase chain reaction (PCR) on all excised corneal buttons regardless of the primary clinical diagnosis. Results: We included 112 eyes of 112 consecutive patients who underwent PK. At the time of PK, 91 (81.25%) patients had no history of HK and 21 (18.75%) patients did. The recipient corneas of 91 patients without a history of HK tested positive for HSV-1 DNA in 12 (13.2%) eyes, for VZV DNA in 3 (3.3%) eyes, and for HSV-1 and VZV DNA simultaneously in 2 (2.2%) eyes. The recipient corneas of 21 patients with a preoperative history of HK tested positive for HSV-1 DNA in 13 (61.9%) eyes and VZV DNA in 1 (4.8%) eye. All patients with positive herpes DNA and no history of HK prior to PK received antiherpetic treatment and had a 100% graft survival rate after 1 year. Conclusions: We found herpesvirus DNA in 18.7% of recipient corneas without clinical suspicion or history of herpes keratitis. This suggests the need of routine HSV-1 and VZV PCR testing in all explanted corneas regardless of clinical suspicion, to detect, treat and prevent possible recurrence of herpes infection in corneal grafts and support graft survival. [ABSTRACT FROM AUTHOR]

Aim: Diagnostic methods for HSV-1 need to be updated. Materials & methods: Serial dilutions of HSV-1 DNA and ocular pathogenic microorganisms were tested by loop-mediated isothermal amplification-lateral flow dipstick assay (LAMP-LFD assay). The reliability of the LAMP-LFD assay and quantitative real-time PCR (qPCR) for HSV-1 detection was also validated using 30 clinical swab samples. Results: The LAMP reaction is optimal at 65°C and 30 min. And the LAMP-LFD assay could detect HSV-1 up to 10 copies/μl and no cross-reactivity with other pathogens was observed. Moreover, LAMP-LFD had similar positive rates to qPCR in clinical samples, and sensitivity and specificity were highly consistent with those of qPCR. Conclusion: LAMP-LFD assay is a rapid technique for the diagnosis of HSV-1. [ABSTRACT FROM AUTHOR]

Although past research has shown an association between obesity and herpes simplex virus infection, the relationship between body mass index (BMI) and herpetic stromal keratitis (HSK) recurrence has never been investigated. In this study, we included HSK patients who received oral valacyclovir as prophylactic treatment between January 2016 and January 2021. Recurrence, possible risk factors, and the time to recurrence were recorded during follow-ups. Among the 56 patients included in this study, recurrence was reported in 21 (37.5%) patients. The age at disease onset and mean follow-up time were not significantly different in the recurrence and non-recurrence groups. However, in the Cox regression analysis, BMI ≥ 24 kg/m2 was noted as the variable having significant correlation with recurrence (p = 0.01 in univariate analysis and p = 0.001 in multivariate analysis). In conclusion, overweight and obesity were revealed as risk factors for HSK recurrence in patients receiving long-term antiviral prophylaxis. Further studies are needed to determine the appropriate acyclovir concentrations in the blood or aqueous humour in order to achieve desirable prophylactic effects, especially in the overweight and obese patients. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmada bir üçüncü basamak sağlık merkezinde uygulanan penetran keratoplasti (PK) ameliyatlarının endikasyon dağılımının ve çalışma periyodu içerisinde bu dağılımda görülen değişimlerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: PK ameliyatı geçiren hastaların tıbbi kayıtları retrospektif olarak incelendi. Endikasyonlar; korneal skar, korneal distrofi, keratokonus, büllöz keratopati, regreft ve akut enfeksiyöz keratit olmak üzere altı ana kategori altında incelendi. Endikasyonların zaman içerisindeki değişimini inceleyebilmek amacıyla çalışma periyodu iki eşit zaman dilimine ayrıldı ve bu iki periyottaki veriler karşılaştırıldı. Bulgular: İki yüz altmış üç hastanın (117 kadın [%44,5], 146 erkek [%55,5]) 303 gözü çalışmaya dahil edildi. Penetran keratoplastinin en sık endikasyonu korneal skarlar (76 göz, %25,1) idi. Enfeksiyöz keratit sekelleri (38/76, %50) korneal skar etyolojisi içerisinde ilk sırayı alırken, etkenlere göre dağılım incelendiğinde herpetik keratite bağlı sekeller (21/38, %55,2) en büyük alt grubu oluşturmaktaydı. Çalışma periyodunun 2. yarısında korneal distrofi nedeniyle uygulanan cerrahilerin oranının azaldığı, regreft uygulanan olguların oranının ise artış gösterdiği saptandı. Sonuç: Çalışmamızda PK’nın en sık nedeni korneal skar olarak bulunmuştur.. Enfeksiyöz keratit ve korneal travma olguları açısından sağlık hizmetlerinin iyileştirilmesi; korneal distrofiler açısından ise akraba evliliklerinin önlenmesine yönelik sosyal projelerin ve genetik danışmanlık hizmetlerinin yaygınlaştırılması, bölgemizde korneal patolojiler kaynaklı görme kayıplarını azaltabilecektir.

Given the scarcity of data regarding ocular complications following COVID‐19 vaccination, the approach toward patients with suggestive symptoms and established clinical practice is lacking. Herein, we report the first case of herpetic endotheliithis and secondary stromal keratitis following inactivated COVID‐19 vaccination who experienced a relapse due to poor adherence. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences of Kocaeli University / Kocaeli Üniversitesi Sağlık Bilimleri Dergisi is the property of Institute of Health Sciences of Kocaeli University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Given the scarcity of data regarding ocular complications following COVID‐19 vaccination, the approach toward patients with suggestive symptoms and established clinical practice is lacking. Herein, we report the first case of herpetic endotheliithis and secondary stromal keratitis following inactivated COVID‐19 vaccination who experienced a relapse due to poor adherence.

Purpose: To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis. Methods: In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016–2020) reported to a tertiary care center, which were presumed to be infectious keratitis on the basis of clinical history and presentation. Results: A total of 121 cases with culture-negative keratitis were included in this study. The mean age of the patients was 48.42 ± 1.89 years, and 53.72% were female. At presentation, the presumed etiology was viral in 38.01%, bacterial in 27.27%, fungal in 8.26%, Acanthamoeba in 6.61%, and unlisted in 28.92% of cases. The most common risk factors were a previous history of ocular surface diseases (96.69%) and contact lens use (37.19%). In total, 61.98% of the patients were already on antimicrobial medication at presentation. The initial management was altered in 79 cases (65.29%) during the treatment course. Average presenting and final (post-treatment) visual acuities (VA) were 0.98 ± 0.04 (LogMAR) and 0.42 ± 0.03 (LogMAR), respectively. A significantly higher frequency of patients with a final VA worse than 20/40 (Snellen) had worse VA at initial presentation (p < 0.0001). A history of ocular surface disease, cold sores, and recurrent infection (p < 0.05) were more commonly associated with a presumed diagnosis of viral keratitis. The patients with presumed bacterial etiology were younger and had a history of poor contact lens hygiene (p < 0.05). Conclusions: We observed a distinct difference in clinical features among patients with culture-negative and PCR-negative keratitis managed for presumed viral and bacterial infections. Although there was significant variability in presentation and management duration in this cohort, the visual outcomes were generally favorable.

Objective: This study aimed to evaluate the long-term results of fine needle diathermy (FND) in the treatment of corneal neovascularization (CoNV) due to herpetic keratitis. Methods: We retrospectively reviewed the data of patients with herpetic keratitis CoNV who underwent FND. The demographic data, intraoperative and postoperative complications, preoperative and postoperative best corrected visual acuity (BCVA), and the number of FND procedure were recorded. Results: Twelve eyes of 12 patients with herpetic keratitis CoNV were included in the study. Two patients (16.7%) were females and 10 were males (83.3%). The mean age was 56.75±13.24 (39–88) years. The mean follow-up period was 20.58±9.79 (12–42) months. The mean number of FND was 1.33±0.65. The mean preoperative BCVA was 1.40±0.44 log MAR, and the mean postoperative BCVA was 1.11±0.52 log MAR (p=0.018). All eyes with herpetic CoNV were categorized based on the resolution of corneal vascularization and visual acuity improvement into complete regression (n=6, 50%), partial regression (n=4, 33.3%), and no regression (n=2, 16.7%). Subconjunctival hemorrhage developed in 2 patients (16.7%). Corneal perforation developed in 1 patient (8.3%) and was treated conservatively. During the follow-up period, no patient had CoNV activation after FND. Conclusion: Our results indicated that FND treatment in CoNV due to herpetic keratitis was effective in preventing CoNV recurrence, and the visual acuity gained after FND treatment was preserved in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to study changes in matrix metalloproteinases and their tissue inhibitors in the tears and blood serum of patients with herpetic keratoconjunctivitis under the influence of antiherpetic antibodies and nimesulide. Materials and methods.65 adult patients with herpetic keratoconjunctivitis (HKC) caused by the herpes simplex virus type 1 (HSV-1) were examined. The etiological diagnosis of HKC was confirmed by polymerase chain reaction. The control group consisted of 32 patients who received basic treatment with acyclovir and interferon in the affected eye. The main group consisted of 33 patients who received antiherpetic immunoglobulin and nimesulide in addition to basic therapy. Immunoglobulin was administered intramuscularly and instilled into the affected eye, and nimesulide was administered orally. The control group consisted of 38 practically healthy adults. Matrix metalloproteinases MMP-1, MMP-8, and MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2 were determined by solid-phase enzyme immunoassay in the tear fluid and blood serum of patients. The results of the study were processed according to the Student's criterion. Results. With HKC in the affected eye, in the acute phase of the disease, there are: an increase in the concentrations of MMP-1, MMP-8, MMP-9, both in the tear fluid and in the blood serum of patients; a decrease in the concentrations of TIMP-1 and TIMP-2 in the tear fluid, with unchanged levels of these compounds in the blood serum; violation of the balance in the corresponding MMP/TIMP systems to the advantage of MMP. In the convalescence phase, these shifts in the concentrations of MMPs, TIMPs and the balance between them significantly decrease, but their complete normalization does not occur, which is most significant for tear fluid than for the blood serum of convalescents. The combination of antiherpetic immunoglobulin and nimesulide helps to inhibit the exces production of MMP-1, MMP-8, MMP-9 in the lacrimal fluid of the causal eye and in the blood serum of patients, optimizes the level of TIMP-1, TIMP-2 and balance in the corresponding MMPs/TIMPs systems. Conclusion. In the acute phase of SCC, MMPs activity prevails, in the convalescence phase, TIMPs activity prevails. The combination of antiherpetic immunoglobulin and nimesulide has a positive effect on the state of MMPs and TIMPs in the lacrimal fluid of the causal eye and in the blood serum of patients.

Koji Hirano,1 Hidenori Tanaka,2 Kumiko Kato,3 Kaoru Araki-Sasaki4 1Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, Aichi, 454-8509, Japan; 2Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; 3Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan; 4Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, 573-1010, JapanCorrespondence: Koji HiranoDepartment of Ophthalmology, Fujita Health University Bantane Hospital, 6-10, Otoubashi 3-cho-me, Nakagawa-ku, Nagoya, Aichi, 454-8509, JapanTel +81-52-321-8171Fax +81-52-322-4734Email kojihira@fujita-hu.ac.jpPurpose: In clinical practice we sometimes encounter patients with severe corneal ulcers who have been treated with topical corticosteroids. This study reviewed the clinical features and visual outcomes of these patients and investigated the background of the prescription of topical corticosteroids.Patients and Methods: The medical records of patients who visited the Cornea Service at Fujita Health University Bantane Hospital and were treated for infectious keratitis from April 2016 to March 2020 were retrospectively reviewed. Patients treated with topical corticosteroids before a culture-proven diagnosis were studied in terms of demographics, best-corrected visual acuity at arrival and at last visit, the clinical course after visit, ocular history, and combination therapy by the previous ophthalmologist.Results: Out of the 200 eyes of 197 patients with infectious keratitis, 14 eyes of 14 patients were treated with topical corticosteroids before a culture-proven diagnosis. All 14 patients were referred, as they had severe keratitis that could not be cured with topical antibiotics and corticosteroids. Based on the culture results, we diagnosed Acanthamoeba keratitis (AK) in six patients, fungal keratitis (FK) in two patients, bacterial keratitis (including a suspected case) in two patients, and unknown cause in four patients. Two patients with AK, FK, and unknown keratitis had unfortunate clinical courses and poor visual outcomes. From the information in the referral letters, at least six of the 14 patients were treated with either acyclovir ocular ointment or valaciclovir tablets, along with topical corticosteroids.Conclusion: Application of topical corticosteroids for keratitis that does not respond to empirical antibiotic therapy is harmful since AK or FK is likely involved in these topical antibiotic-resistant cases. Microbiological evidence, as well as a differential diagnosis of herpetic stromal keratitis, is needed when prescribing topical corticosteroid for the treatment of suspected infectious keratitis.Keywords: culture-proven diagnosis, empiric antibiotic therapy, herpetic keratitis, infectious keratitis, topical corticosteroids

Kuo-Hsuan Hung,1– 3 Yu-Hsiang Lan,2,4 Jui-Yen Lin,1,2 Eugene Yu-Chuan Kang,1,2 Hsin-Yuan Tan,1,2 Hung-Chi Chen,1,2 Ching-Hsi Hsiao,1,2 Lung-Kun Yeh1,2 1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan; 2Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan; 3Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan; 4Department of Medicine, Chang Gung University, Taoyuan 333, TaiwanCorrespondence: Lung-Kun YehDepartment of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No 5, Fusing St., Taoyuan 333, TaiwanTel +886-3-3281200, ext. 8666Fax +886-3-3287798Email yehlungkun@gmail.comPurpose: To evaluate the role of Demodex infestation of the eyelids in patients with recurrent herpetic keratitis.Patients and Methods: This is a retrospective and noncomparative case series. Twenty-seven patients with ocular demodicosis and recurrent herpetic keratitis under conventional treatments were enrolled. Demographic data and clinical photographs were collected. Ocular demodicosis was confirmed by eyelash examination under a microscope. Eyelid scrub was initiated in these patients after proving Demodex infestation. Response after treatment was reviewed.Results: Herpetic keratitis was characterized by epithelial defect, including dendritic lesions (seven eyes, 25.9%), geographic ulcer (three eyes, 11.1%), and neurotrophic ulcer (two eyes, 7.4%), associated with stromal involvement in 12 cases. Six cases with stromal reactivation, including disciform keratitis (two eyes, 7.4%), immune ring (three eyes, 11.1%), and ghost vessel (one eye, 3.7%), presented no epithelial defect. Active anterior uveitis with keratic precipitates was found in 15 cases. Demodex blepharitis was diagnosed with cylindrical dandruff along their lashes in all patients. Other ocular findings include meibomian gland dysfunction (15 eyes, 55.6%), mal-aligned lashes (eight eyes, 29.6%), telangiectasia (14 eyes, 51.9%), conjunctivitis (18 eyes, 66.7%), and ocular rosacea (three eyes, 11.1%). Initial unstable clinical presentations showed deterioration of corneal melting into descemetocele, corneal perforation, recalcitrant stromal infiltration/uveitis, and uncontrollable IOP, despite antiherpetic medication. After treatment of Demodex blepharitis, infestation was under control, followed by subjective improvement of ocular symptoms and a stable clinical outcome.Conclusion: Ocular demodicosis should be considered in patients with unstable recurrent herpetic keratitis. A prompt diagnosis and appropriate treatment may curb the progression of herpetic corneal infection.Keywords: blepharitis, Demodex mites, herpetic keratitis, ocular demodicosis

Purpose: To strengthen the sparse evidence on acyclovir (ACV) resistance, especially in recalcitrant herpetic keratitis (HK), by describing the clinical course of 3 genotypically proven ACV resistant HK cases. An overview of mechanisms of resistance and therapeutic options currently available to ophthalmologists is provided based upon recent literature search. Observations: Resistance to ACV due to known mutations in the gene encoding the viral thymidine kinase was confirmed in 2 cases, and a novel mutation in the UL23 gene (N202K) conferring phenotypical resistance to ACV was discovered in 1 case. Three unique therapeutic strategies finally led to epithelial closure. Conclusions: The novel thymidine kinase mutation (N202K) should be considered to infer resistance to all molecules requiring activation by the viral thymidine kinase. Current topical alternatives in the ophthalmologist's armamentarium include trifluridine 1%, foscarnet 1,2%-1,4% or cidofovir 0,2–0,5%. Epithelial debridement, high-frequency dosing and dose reduction of immunosuppressive therapy are useful adjuncts. Importance: Clinicians should consider performing epithelial debridement in recalcitrant HK, allowing geno- and phenotypically guided therapy. This report provides mandatory knowledge allowing the reader to comprehend how therapy should be altered based upon these results. To the best of our knowledge, only 2 cases of proven ACV resistant HK treated with topical foscarnet have been published before.Furthermore, this paper highlights a lack of controlled studies investigating alternative topical treatments in case of viral resistance, offering opportunities for future research.

Purpose: To determine herpes simplex virus (HSV) DNA prevalence and mean cycle threshold of polymerase chain reaction (PCR) in corneal tissue of patients with penetrating keratoplasty (PKP), with (HSK+) and without (HSK−) previous clinical herpetic keratitis history. Methods: Retrospective review of recipient corneal buttons which were explanted through PKP between March 2010 and September 2018 at the Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar, Germany. Corneal tissue samples were analysed by real‐time PCR for the presence of HSV DNA. For each subject, clinical data, including patients' demographics and clinical diagnoses, were collected. Results: In total, 2230 corneal samples (age at the time of the surgery 57.3 ± 19.2 years) of 1860 patients were analysed. HSV PCR was positive in 137 (6.1%) corneal samples, with a 30.57 ± 6.01 (range 14–39) mean cycle threshold (Ct) value. Two hundred ninety‐eight (13.4%) corneas of 266 patients were clinically HSK+, and 1932 (86.6%) corneas of 1600 patients were clinically HSK−. HSV DNA was detected significantly more frequently (p < 0.0001) in HSK+ corneal samples (108 corneal samples; 36.2%), than in HSK− corneal samples (29 corneal samples; 1.5%). Ct value was significantly lower in HSK+ than in HSK‐ corneal samples (29.8 ± 5.8 versus 32.6 ± 5.9; p = 0.008). Conclusion: Our data demonstrate that a positive clinical history of HSK is related to HSV PCR positivity in about every 2.8th patient. In addition, about every 66th explanted corneal tissue is HSV PCR‐positive despite the lack of clinical suspicion. These patients may need additional local/systemic antiviral treatment to avoid newly acquired HSK following penetrating keratoplasty. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence and reasons for delays in diagnosis in patients with Acanthamoeba keratitis (AK) presenting to Wilmer Eye Institute, Baltimore, Maryland. Methods: This retrospective study analysed all patients with culture‐positive AK seen between 2012 and 2019 at a tertiary referral centre. Patient demographic information, clinical history, risk factors, symptom duration, referral patterns, slit lamp examination findings, visual acuity and need for surgery were collected. Results: The study included 45 eyes of 43 patients. On average, patients were symptomatic for 52.6 days before culture collection. Thirty‐one percent of patients were diagnosed within 28 days of symptom onset while 69% were diagnosed after 28 days. Before presentation to a tertiary care centre, 69% of patients were evaluated by an ophthalmologist outside of this institution and 27% were evaluated by a provider other than an ophthalmologist. AK was most commonly misdiagnosed as herpetic keratitis, occurring in 38% of patients. The strongest risk factor for AK was contact lens use. Only 11% of patients presented with the classic ring infiltrate and 82% had pain. Patients with an early versus late diagnosis had a mean Snellen visual acuity (VA) of 20/224 versus 20/296 at presentation (p = 0.33) and a mean Snellen VA of 20/91 versus 20/240 at final visit (p = 0.07). 11% of patients required a therapeutic penetrating keratoplasty. Conclusion: Delayed diagnosis of AK in our cohort occurred due to a misdiagnosis as herpetic keratitis, non‐specific clinical signs including the lack of pain in a number of patients, and a delay in referral to a tertiary care centre. Any contact lens wearer with an atypical keratitis should be referred promptly for Acanthamoeba cultures. [ABSTRACT FROM AUTHOR]

Majid Moshirfar,1– 3 Dallin C Milner,4 Preston A Baker,5 Shannon E McCabe,1 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Colorado School of Medicine, Aurora, CO, USA; 5McGovern Medical School, University of Texas Health Science Center, Houston, TX, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT 84020, USATel +1 801-568-0200Email Cornea2020@me.comAbstract: The incidence of herpes simplex keratitis (HSK) in patients following corneal refractive surgery is higher than in the general population, and several case reports of ocular morbidity in HSK infection following corneal refractive surgery have been published. HSK is listed by the American Academy of Ophthalmology as a relative contraindication to corneal refractive surgery, although specifics have not been further elucidated. This review summarizes the current literature regarding reactivation of HSK following corneal refractive surgery and provides a guideline for considering corneal refractive surgery in a patient with a previous history of HSK. Based on the current literature, we recommend that corneal refractive surgery is appropriate for patients with a history of HSK without multiple recurrences who have had no evidence of disease for at least one year. In addition to a thorough history and physical examination, we also recommend these patients begin 400 mg twice daily of oral acyclovir or valacyclovir 500 mg once daily for two weeks prior to surgery and continue this regimen for at least two weeks postoperatively or while on topical steroids.Keywords: herpetic keratitis, LASIK, PRK, PTK, herpes prophylaxis, SMILE, HSV, shingles, varicella zoster, cytomegalovirus, CMV

Purpose: To describe and analyze the microstructural changes in herpetic stromal keratitis (HSK) observed in vivo by spectral-domain ocular coherence tomography (SD-OCT) at different stages of the disease. Methods: A prospective, cross-sectional, observational, and comparative SD-OCT analysis of corneas with active and inactive keratitis was performed, and the pathologic differences between the necrotizing and non-necrotizing forms of the disease were analyzed. Results: Fifty-three corneas belonging to 43 (81.1%) women and 10 (18.8%) men with a mean age of 41.0 years were included for analysis. Twenty-four (45.3%) eyes had active keratitis, and 29 (54.7%) had inactive keratitis; the majority (83.0%) had the non-necrotizing form. Most corneas (79.1%) with active keratitis showed stromal edema and inflammatory infiltrates. Almost half of the active lesions affected the visual axis, were found at mid-stromal depth, and had a medium density. By contrast, corneas with inactive keratitis were characterized by stromal scarring (89.6%), epithelial remodeling (72.4%), and stromal thinning (68.9%). In contrast to non-necrotizing corneas, those with necrotizing HSK showed severe stromal scarring, inflammatory infiltration, and thinning. Additionally, most necrotizing lesions (77.7%) affected the visual axis and had a higher density (P = 0.01). Conclusion: Active HSK is characterized by significant epithelial and stromal thickening and the inactive disease manifests epithelial remodeling at sites of stromal thinning due to scarring. Necrotizing keratitis is characterized by distorted corneal architecture, substantial stromal inflammatory infiltration, and thinning. In vivo SD-OCT analysis permitted a better understanding of the inflammatory and repair mechanisms occurring in this blinding corneal disease.

Purpose The aim of this study was to report the results of femtosecond laser-assisted anterior lamellar keratoplasty (FS-ALK) for treatment of herpetic corneal scars in a small group of cases. Patients and methods A noncomparative case series of eight eyes with postherpetic stromal corneal scars underwent FS-ALK using the Alcon WaveLight FS-200. The donor and recipient corneas were cut using the same parameters at 70% depth from the thinnest location of the recipient cornea. The donor cornea was sutured using eight interrupted sutures. The main outcome measures included preoperative and postoperative uncorrected visual acuity and best-corrected visual acuity (BCVA, LogMar). Anterior segment optical coherence tomography was done preoperatively and 1 month after suture removal. Complications were documented. Results The procedure was uneventful in all eyes with easy separation of the precut lenticule with no intraoperative complications. The BCVA improved significantly in 7/8 (87.5%) eyes. The mean preoperative BCVA was 0.88±0.15 LogMar and improved 1 month after suture removal to 0.36±0.15 LogMar (P=0.00001). Conclusion The FS-ALK is a safe, easy, and effective procedure for the treatment of herpetic corneal scars.

Purpose. To identify problems contributed to the development of a chronic course of herpetic keratitis/keratouveitis and to suggest ways to solve them (taking into account the results of virological examination by PCR). Patients and methods. A group of patients (n = 90) with herpetic keratitis/keratouveitis of the prolonged course was under observation. Biological secretions (tears, saliva, blood serum and urine) of patients were investigated for the presence of herpes simplex virus (HSV), varicella-zoster virus (VVZ), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), human herpesvirus type 7 (HHV-7) by polymerase chain reaction (PCR). Antiherpetic therapy included systemic oral administration of selective analogues of nucleosides (AN) — valacyclovir and phamcyclovir in daily doses of 2–3 g and 1.5 g, respectively. Local therapy included installations of mydriatic (if necessary), non-steroidal anti-inflammatory agents, antibacterial drugs. Reparative therapy consisted in prescribing conservative installations of HILOPARIN-COMOD® and PARIN-POS® ointment. Results. The clinical picture of herpetic keratitis/keratouveitis was presented by surface forms — 22 cases, deep forms — 68 cases. Positive results of HSV determination were obtained in 34.6 % of the surveyed. VZV was detected in 21 cases (28 %), CMV — in 14.6 %. EBV was detected in 28 cases (37.3 %), HHV-6 — in 37 cases (49.3 %). Genetic material of HHV-7 was found in 32 % of the examined. The results of PCR studies determined the appointment of adequate doses of nucleoside analogues (NA), which led to relief of symptoms in 100 % of cases. Active reparative therapy contributed to complete persistent epithelialization sustained by systemic use of NA in all cases within 4 weeks from the presentation. Conclusion. The results of PCR examination for the production of herpetic viruses in the tear/saliva/blood/urine are crucial to confirm the etiology of keratitis/keratouveitis, as well as determine the appointment of adequate (increased) doses of nucleoside analogues according to the recommended regimens until remission is achieved. Local therapy drugs should be used on the principle of “necessary minimum”. Therapeutic scheme for herpetic keratitis/keratouveitis already in the active stage should include local drugs with reparative effect, contributing to the achievement of persistent epithelialization.

Purpose: Chronic inflammation is a predisposing factor for metaplastic changes and ultimately dysplasia. We describe cases of OSSN occurring in the setting of chronic ocular surface inflammation., Methods: Sixteen eyes from 14 individuals were included from one ocular oncology clinic between 2010 and 2023. Patients presented with ocular surface squamous neoplasia (OSSN) in the setting of chronic inflammation. The diagnosis of OSSN was made using anterior segment high-resolution optical coherence tomography (HR-OCT) and confirmed by histopathological analysis in all cases., Results: Median age on presentation was 61 [IQR 47.5-69.2] years. Eleven (86%) individuals were male and five (36%) identified as White Hispanic. Ten eyes were referred with ocular surface diagnoses including pannus (n = 4), scarring (n = 3), pterygium (n = 2), and herpetic keratitis (n = 1). Only six eyes were referred as possible neoplasia. All individuals had a history of ocular surface inflammation. The most common inflammatory conditions were ocular rosacea (seven individuals) and atopic keratoconjunctivitis (AKC) (five individuals). Two individuals were found to have bilateral OSSN, one in the setting of ocular rosacea and the other in the setting of AKC. All 16 eyes from 14 individuals were suspected to have OSSN based on HR-OCT findings which guided the location of the incisional biopsies that subsequently confirmed histopathological diagnosis in all cases., Conclusion: OSSN may arise in the setting of chronic inflammation on the ocular surface. Identification of the tumor can be challenging in these cases, and HR-OCT can be a key diagnostic tool in detecting OSSN., (Copyright © 2024. Published by Elsevier Inc.)

Although past research has shown an association between obesity and herpes simplex virus infection, the relationship between body mass index (BMI) and herpetic stromal keratitis (HSK) recurrence has never been investigated. In this study, we included HSK patients who received oral valacyclovir as prophylactic treatment between January 2016 and January 2021. Recurrence, possible risk factors, and the time to recurrence were recorded during follow-ups. Among the 56 patients included in this study, recurrence was reported in 21 (37.5%) patients. The age at disease onset and mean follow-up time were not significantly different in the recurrence and non-recurrence groups. However, in the Cox regression analysis, BMI ≥ 24 kg/m2 was noted as the variable having significant correlation with recurrence (p = 0.01 in univariate analysis and p = 0.001 in multivariate analysis). In conclusion, overweight and obesity were revealed as risk factors for HSK recurrence in patients receiving long-term antiviral prophylaxis. Further studies are needed to determine the appropriate acyclovir concentrations in the blood or aqueous humour in order to achieve desirable prophylactic effects, especially in the overweight and obese patients.

Purpose: The aim of this study was to investigate the indication distribution for penetrating keratoplasty (PK) surgeries performed in our clinic and the changes observed in this distribution during the study period. Materials and Methods: Medical records of patients who underwent PK were retrospectively reviewed. Indications were examined under six main categories; corneal scarring, corneal dystrophy, keratoconus, bullous keratopathy, regraft and acute infectious keratitis. In order to examine the changes in indications over time, the study period was divided into two equal time periods and the data in these periods were compared. Results: 303 eyes of 263 patients (117 women [44.5%], 146 men [55.5%]) were included in the study. The most common indication for penetrating keratoplasty was corneal scars (76 eyes, 25.1%). While infectious keratitis sequelaes (38/76, 50%) took the first place in the etiology of corneal scarring, sequelaes due to herpetic keratitis (21/38, 55.2%) were the largest subgroup whereas the distribution according to the microbial agents was examined. In the second half of the study period, the rate of surgeries performed due to corneal dystrophy decreased, whereas the rate of patients who underwent regraft increased. Conclusion: The most common indication for PK was corneal scarring in this study. Improving health services in terms of infectious keratitis and corneal trauma cases; dissemination of social projects and genetic counseling services for the prevention of consanguineous marriages in terms of corneal dystrophies will reduce vision loss due to corneal pathologies in this region. [ABSTRACT FROM AUTHOR]

Introduction. Herpetic keratitis caused by the herpes simplex virus (HSV) is the most common form of ocular herpes that causes corneal blindness. Although treatments for herpes keratitis have improved in recent years. there is still considerable room for new treatments against viral infection that shows great promise. The aim of the study was to evaluate the effect of RNA interference on HSV Type 1 (HSV1) infection in vitro, first prophylactically then therapeutically. Material and methods. The highly conserved glycoproteins D (gD) and E (gE) were chosen as targets for this study. Different small interfering RNA (siRNA) duplexes that target gD and gE were designed and chemically synthesized. The recombinant adenovirus type 5 was developed and used as the vehicle with which we delivered the siRNA into the Vero cells infected with the HSV1 KOS strain. Evaluation of the efficacy of siRNA-mediated inhibition was performed either before virus inoculation (prophylactically) or after virus inoculation at the first appearance of lesions (therapeutically). The expression of messenger RNA encoding gD and gE was detected using a real-time polymerase chain reaction (qPCR). We analyzed HSV replication in Vero cells, cytotoxicity of HSV, and cell viability. Results. When used prophylactically, the siRNA-targeting gD and gE created a more marked decrease in viral titer than when used therapeutically. The transfection of cells with recombinant adenovirus containing the siRNA expression cassette was associated with very low cytotoxicity. Conclusions. Adenovirus-mediated siRNA-targeting gD and gE genes effectively inhibit the replication of the HSV in Vero cells. In addition, these findings indicate that the prophylactic use of siRNA is far more effective at inhibiting HSV replication than the therapeutic use. [ABSTRACT FROM AUTHOR]

Abstract Purpose Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus. Case report An 18-year-old boy underwent corneal collagen crosslinking in both the eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in 5 days. Seven days later, the patient returned with severe pain, redness, and photophobia for the last 2 days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both the eyes and the corneal sensation was reduced. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment, and the cornea had a faint scar at 1 month follow-up with best-corrected visual acuity of 6/9 in both eyes with a rigid gas permeable lens. Discussion and conclusion Ultraviolet A light could be a stimulus to trigger reactivation of latent HSV infections even in patients with no history of clinically evident herpes virus ocular infections. Early diagnosis and timely treatment can have good visual outcome. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.

Objective. To determine the characteristics of drug therapy in patients with herpetic keratitis (HK), based on laboratory diagnosis.Material and methods. 49 patients with clinical symptoms of HK were included in the study. The conjunctival cells were used as a material for laboratory diagnosis of adenovirus and enterovirus infection by polymerase chain reaction (PCR) and for microbiological examination. Herpesvirus DNA in tears, saliva, urine and blood was determined using PCR (for varicella-zoster virus (VZV) and human herpesvirus type 7 (HHV-7)) and real-time PCR (for herpes simplex virus types 1 and 2 (HSV-1,2), Epstein-Barr virus (VEB), cytomegalovirus (CMV) and human herpesvirus type 6 (HHV-6). Tear and urine were examined for the presence of DNA of obligate intracellular parasites (chlamydia, ureaplasma, and mycoplasma) by PCR.Results. Сlinical picture of HK was presented by superficial (57.1 %, n = 28) and deep forms of corneal inflammation (42.9 %, n = 21). The results of laboratory diagnostics of herpetic infection had showed replication of herpesviruses in all examined patients. Genetic material of herpesviruses in lacrimal fluid was found in half of the examined patients (51 %), in saliva — in 67,3 % of cases. Viruria was observed in 21 patients (42.9 %), viraemia in 6 (12.2 %). DNA of intracellular parasites in lacrimal fluid was detected in 18.4 % of patients and in urine — in 12.2 % of patients. Bacteriological sowing of the conjunctiva scrape was positive in 75.5 % of cases.Conclusion. Instrumental diagnostics (visometry, biomicroscopy) of HK should be supplemented with laboratory research of activity of not only herpesvirus infection, but also bacterial pathogens. Positive results of microbiological sowing of conjunctival scrapers allow to approach reasonably the prescription of antimicrobial drugs in patients with HK.

Herpes simplex keratitis (HSK) is a severe ophthalmic pathology which comprises 20-50% of inflammatory diseases in the cornea. Since keratitis is characterized by a long-term duration, severity, and a tendency to recurrence, studies on ophthalmic herpes and searches for new treatments are of great relevance. Our clinical case demonstrated successful combined treatment of a recurrent stromal herpetic corneal lesion with ulceration. Both treatments, conservative (complex etiotropic, anti-viral, anti-inflammatory, and nutrition-improving) and surgical (an onlay technique), were successful. At 12 months after surgery, the patients had no pain syndrome; the corneal surface was epithelialized. No recurrence of herpetic keratitis was observed. Thus, a combination of etiotropic pathogenic treatment and AM transplantation appears to be effective for severe long-lasting recurrent herpetic keratitis with the presence of defects on the corneal surface.

In June 2020, a 28-year-old female patient was admitted to our clinic with reduced vision in the left eye. She had systemic COVID-19 infection in May 2020 and during her treatment course, her visual complaints had begun approximately 1 week after the beginning of the COVID-19. Previously, the patient had bilateral femtosecond assisted -- Laser in situ Keratomileusis in our clinic in 2018. There was no previous history of herpetic eye involvement. In her examination, the uncorrected visual acuity was 20/20 in the right and 20/32 in her left eye. Slit-lamp examination revealed interlamellar infiltration at the flap interface in the left eye. Considering herpetic activation, ganciclovir ointment 5 x 1, valacyclovir tablet 2 x 1, and prednisolone acetate 1.0% eye drops 5 times a day and artificial tear 5 x 1 were started. Two weeks later, the infiltration completely resolved and the uncorrected visual acuity increased to 20/20. [ABSTRACT FROM AUTHOR]

Purpose: Only recently Tintelnotia was described as a new genus in the Phaeosphaeriaceae family of fungi containing two species, T. opuntiae and T. destructans. Until now, T. destructans keratitis was associated with contact lens wear and ocular trauma. We present the first case of T. destructans keratomycosis presenting as a superinfection in herpetic keratitis. Observations: We present a case of a 53-year-old woman who presented with a unilateral keratitis since 3 weeks without history of trauma or contact lens wear, not responding to topical ofloxacin. Polymerase Chain Reaction (PCR) of the corneal ulcer was positive for Herpes Simplex Virus type 1 (HSV-1). Signs and symptoms progressively improved after starting topical and systemic antiviral therapy. Six weeks later however, our patient presented with a new white infiltrate in the previous herpetic epithelial defect. In vivo confocal microscopy showed fungal hyphae and culture from corneal scrapings identified a hyphomycete. Intensive antimycotic therapy could not prevent a corneal perforation 1 week later. Penetrating keratoplasty was performed with intracameral injection of amphotericin B. Culture of the corneal button and PCR and sequence analysis on the fungal isolate confirmed the diagnosis of T. destructans keratomycosis. Six months after penetrating keratoplasty, biomicroscopy showed a clear graft without recurrence of fungal activity. Conclusions and importance: T. destructans is an emerging opportunistic pathogen causing severe keratomycosis. Despite intensive antimycotic therapy, rapid progression to corneal perforation can be seen. Early diagnosis using confocal microscopy, fungal culture and PCR can allow prompt initiation of treatment, which should be guided by in vitro susceptibility testing.

Introduction. Dry eye syndrome has drown a special attention of ophthalmologists not only because of its prevalence but also due to the increased frequency among patients with inflammatory processes in the cornea and conjunctiva. Purpose. To study the effect of bioflavonoid quercetin on the course of the inflammatory process in patients with herpetic keratitis (HK) and dry eye syndrome (DES). Material and Methods. Clinical study involved 40 patients (40 eyes) with HK (superficial keratitis) and DES; in addition, we followed up 17 patients (17 eyes) with HK-only. All patients involved in the clinical study were divided into two groups: Study Group, HK and DES patients receiving bioflavonoid quercetin, containing in Lipoflavon drug, in addition to traditional treatment, 15 patients; Control Group, HK and DES patients receiving only traditional treatment, 25 patients. Results. Clinical study findings showed that the inclusion of bioflavonoid quercetin (Lipoflavon) in the complex treatment of HK patients with DES significantly decreased the intensity of clinical signs and made it possible to decrease the treatment duration. Corneal dendritic ulceration epithelization was observed significantly earlier in patients with HK and SED receiving Lipoflafon as compared to controls, at Day (4.7±0.4) vs. Day (6.8±0.6), respectively; no corneal infiltration was observed at Days (5.5±0.5) and (7.8±0.7) in Study and Control groups, respectively. Schirmer test II values were (10.47±0.83) mm/5 min and (7.36±0.28) mm/5 min in Study and Control groups, respectively. Tear break-up time equaled (6.13±0.32) and (5.24±0.19) s, in Study and Control groups, respectively. Conclusions. Inclusion of bioflavonoid quercetin in the complex treatment of patients with herpetic keratitis and dry eye syndrome significantly increases the therapy efficacy, which is evidenced by accelerated corneal epithelization and infiltrate dispersion and significantly improved qualitative and quantitative characteristics of tear production.

This article presents modern aspects of clinical manifestations, laboratory diagnostics and treatment of herpetic keratitis (HK). A total of 68 patients participated in the study. In 75 percent of patients high relapse rates of Herpes Simplex skin infection were revealed in the period before HK onset (one-six times per year). Trigger factors for keratitis were thoroughly analyzed. Among them we discovered a number of new ones: the instillation of prostaglandin analogues, paranasal sinus surgery, septoplasty and blepharoplasty. 51 out of 68 patients had active herpetic keratitis, whereas 17 people were in the remission phase. Polymerase chain reaction (PCR) test results for the herpes viruses (HSV, VZV, CMV, EBV, HHV-6) in various body fluids (tears, saliva, blood and urine) from patients with HK are discussed. Herpesvirus DNA was determined in 96 percent of cases (49 out of 51 patients with active HK). Among these 49 patients a monoinfection was detected in 47 percent of cases and mixed infection - in 53 percent. According to the obtained results, we proposed some optimized treatment solutions // Russian Ophthalmological Journal, 2017; 1: 90-7. doi: 10.21516/2072-0076-2017-10-1-90-97.

This study is to investigate the characteristic features of Acanthamoeba keratitis (AK) that differentiating it from herpetic epithelial keratitis (HEK) using anterior segment optical coherence tomography (AS-OCT). Medical records of three eyes of each AK and herpetic keratitis who had AS-OCT examination were reviewed in this study. Slit-lamp biomicroscopy and AS-OCT was performed on the initial visit and on every follow-up visits in all patients. In all three AK cases, reflective bands in the corneal stroma that correspond to the area of radial keratoneuritis were observed. The depth of the reflective bands varied in each case. After AK treatment, slit-lamp biomicroscopy confirmed that radial keratoneuritis had resolved and AS-OCT confirmed that reflective bands in the corneal stroma had also disappeared in all patients. Unlike the AS-OCT results found in AK, highly reflective HEK lesions were observed only in the subepithelial area, not in the stroma. AS-OCT seems to be helpful analyzing the specific depth of the lesion which enables to distinguish AK from HEK.