J Korean Ophthalmol Soc.  2007 Sep;48(9):1212-1219.

Clinical Analysis of Herpetic Keratitis in Korea

• Hwang JS
• Wee WR
• Lee JH
• Kim MK

Abstract

PURPOSE: To investigate the clinical characteristics of herpetic keratitis in Korea.
METHODS
A retrospective analysis was performed on 90 eyes of 84 patients who were clinically diagnosed with herpetic keratitis and were followed for at least 4 months or more. Information on prior herpetic keratitis, type of keratitis, time to remission, recurrence rate, administration of oral acyclovir, final visual acuity was reviewed. Remission time and recurrence rate were compared according to types of herpetic keratitis and the application of oral acyclovir in epithelial, stromal or endothelial keratitis; and the relation of history of previous herpetic keratitis, recurrence and final vision, was analyzed.
RESULTS
Sex ratio (M:F) was 1.31 and the mean age was 54.6 years. Of 90 eyes, the proportion of infectious epithelial keratitis, stromal keratitis, endothelitis and neurotrophic ulcer was 51.1, 17.8, 25.6 and 5.6%, respectively. The mean remission time was 1.92+/-1.01, 4.13+/-5.05, 5.52+/-5.08, 4.00+/-1.00, respectively (p=0.001, one-way Anova). Recurrence occurred in 21 (42.9%) eyes of 49, which were followed up for more than 12 months, in a year after the previous attack. The rates of recurrence of infectious epithelial keratitis, stromal keratitis and endothelitis were 25.0%, 63.6% and 53.8%, respectively. Oral acyclovir neither shortens the remission nor prevents the recurrence. The percentage of final vision over 20/40 in infectious epithelial keratitis, stromal keratitis and endothelitis was 81.1, 57.1 and 60.0%, respectively. The final vision was worse in the group with a history of herpetic keratitis.
CONCLUSIONS
Stromal keratitis and endothelitis showed a higher recurrence rate and longer remission time than infectious epithelial keratitis. Because recurrent and severe keratitis may result in corneal opacity and vision loss, aggressive and proper treatment is needed. However, these cases are often resistant to therapy.

Keyword

Herpes simplex keratitis; Oral acyclovir; Recurrence; Visual loss; Stromal keratitis

MeSH Terms

Acyclovir
Corneal Opacity
Humans
Keratitis
Keratitis, Herpetic*
Korea*
Recurrence
Retrospective Studies
Sex Ratio
Ulcer
Visual Acuity
Acyclovir

Figure

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  Figure 1. Figure 1. Comparison of the mean remission time between various types of herpetic keratitis, and the effect of oral acyclovir on remission time. Error bar: ±2 standard deviation. Group I: Infectious epithelial keratitis. II: Stromal keratitis. III: Endothelitis. IV: Neurotrophic keratitis. p: Independent t-test between oral acyclovir-administered group and not-administered group.

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  Figure 2. Recurrence of herpetic keratitis: Survival analysis by Kaplan-Meier test between the patients with oral acyclovir administration and without administration. Logrank test: p=0.28.

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