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Gordon Crabtree, Tamara Vrabec, Vincent D Baldassano; Polymerase Chain Reaction (PCR) for Varicella Zoster Virus (VZV) in VZV Keratitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3786. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
VZV keratitis is generally accepted to be an immune response rather than an active viral infection. Consequently, current treatment paradigms generally recommend steroids rather than antiviral agents. The purpose of this investigation is to determine the prevalence of positive polymerase chain reaction (PCR) in suspected cases and to identify predictive or associated factors.
In this retrospective analysis, we identified 22 patients who presented to Geisinger Eye Institute with a clinical diagnosis of acute VZV keratitis and who underwent corneal swab and PCR for VZV. Univariate analysis of eyes positive (group 1) and negative (group 2) for VZV was performed to identify differentiating factors.
All participants had a history of VZV rash and all but one had pseudodendrites at the time of swab. Thirteen of 22 eyes (59.1%) had positive PCR for VZV. Mean time between rash and first ocular sign was 1.39 months (range -1 to 6.75) in group 1 and 10.63 months (range 0.1 to 32.78) in group 2 (p=0.006). Mean time from rash to swab was 1.9 months and 10.64 months in groups 1 and 2 respectively (p=0.01). Rash in the V1 distribution concurrent with pseudodendrites was present in 77% and 33% in groups 1 and 2 respectively (p=0.043). No significant differences in systemic immune-suppression due to disease or medication were identified
PCR was positive for VZV in the majority of eyes that presented with acute keratitis and pseudodendrites. Recent VZV rash in the V1 distribution concurrent with pseudodendrites were significantly associated with positive PCR. Further research is needed to determine the role of antiviral therapy in VZV keratitis.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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