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Ilya Sluch, Justin Dvorak, Kai Ding, Jennifer Wu; Recurrent Herpetic Keratitis risk factors: an experience at a tertiary referral center in the United States.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6204.
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© ARVO (1962-2015); The Authors (2016-present)
The recurrent nature of herpetic keratitis, specifically herpes simplex virus, makes it difficult to treat. The risk factors for herpetic keratitis recurrence have remained elusive. Identifying ocular and systemic risk factors associated with recurrent herpes keratitis can help identify high risk patients and guide treatment. The purpose of the present study was to describe the various clinical presentations and ocular complications of recurrent Herpesvirus Keratitis and explore all previously-reported recurrence risk factors in our patient population.
A retrospective study of patients diagnosed with recurrent herpesvirus keratitis at Dean McGee Eye Institute between April 2013 and February 2015 was performed. The electronic medical records system was searched for prescriptions of antiviral medication and reviewed for documentation of keratitis. Data on demographics, medical co-morbidities, ocular co-morbidities, ocular complications, type of keratitis, and need for chronic anti-viral or steroid medications were collected. Statistical analysis was carried out using the Chi-square test, Fisher’s exact test, and a 2-sample t-test.
A total of 75,939 patients were seen at DMEI between April 2013 and February 2015 of which 264 had at least one recurrence during their lifetime. 64 (24.2%) had a recurrence during the study period. The majority of our patients were female (60%) with an average age of 62.9 years (11-92). The most common comorbidities included ocular surface disease (81.8%), hypertension (52.4%), and previous cataract surgery (31.1%). Stromal keratitis was the most common form of recurrence comprising 59.1%. The most common complication was a visually-significant scar of 76.5%. 92.8% of patients were on chronic antiviral therapy and 59.5% were on chronic topical steroids.
Overall, our study suggests that ocular surface disease is a significant risk factor for recurrent herpetic eye disease, particularly stromal keratitis. We hypothesize that the pro-inflammatory ocular environment caused by dry eye is aiding in disease reactivation. While chronic antiviral prophylaxis is beneficial to reducing the recurrence rate, 24% of our patients had recurrence while on prophylaxis.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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