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T. Hoang–Xuan, N. Alfonsi, L. Racine, G. Sultan, C. Baudouin, E.E. Gabison; Archipelago Keratitis: A Herpes Mediated Epithelial Cell Activation Syndrome? . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2619.
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Purpose: To report 5 cases of Archipelago keratitis, a distinct entity of herpetic epithelial keratitis and to propose a hypothesis regarding the physiopathogenesis of this syndrome. Methods: Case report with clinical examination, corneal scraping for Herpes PCR and in vivo HRT2 confocal microscopy.Results: We describe a form of herpetic keratitis consisting of a limbal infiltrate associated with epithelial erosions which have a linear centripetal disposition. All the patients had a past history of herpetic keratitis. The evolution over 3 weeks was marked by the appearance of nummular subepithelial opacities. Corneal scraping performed in 3 cases revealed positive PCR for herpes simplex in two cases (HSV1, HSV2). Confocal in vivo microscopy (HRT2 with corneal unit ) revealed the presence of ballooned epithelial cells and subepithelial infiltrates of inflammatory cells. All the patients healed with oral valacyclovir treatment.Conclusions:We believe that during the evolution of a limbal recurrence of herpetic disease, inflammatory mediators may in some cases promote the migration of limbal epithelial cells towards the center of the cornea, hence facilitating the dissemination of the viral infection.
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