Abstract
Purpose :
Herpetic keratitis (HK) is one of the leading infectious causes of corneal blindness in developed countries. Even after resolution of acute episodes, patients are often confronted with a high rate of recurrence and a variety of sequelae. One such sequela that has been anecdotally noted following HK is the development of Limbal Stem Cell Deficiency (LSCD). However, no studies to date have investigated the clinical correlation between HK and LSCD. In this retrospective cohort study, we describe the demographic features and clinical characteristics of patients with HK and LSCD.
Methods :
Records of patients with a clinical diagnosis of HK seen at the Massachusetts Eye and Ear Infirmary from June 2013 to June 2018 were reviewed for evidence of LSCD. Patient demographics including age, gender and race were reviewed, and for the purpose of this retrospective study, patients were defined as having LSCD based on ICD diagnosis code and/or clinical exam findings characteristic of LSCD in any number of clock hours. These included presence of superficial neovascularization, attenuation or loss of limbal palisades, loss of normal corneal luster with conjunctivalization and fibrovascular pannus formation across the limbus, as well as a clinical course characterized by frequent epithelial breakdown and persistent epithelial defects.
Results :
We identified 403 patients diagnosed with HK. The average age of these patients was 57.5 years; 164 (41%) were male and 279 (59%) were female; 15 (4%) were pediatric; and 369 (92%) were Caucasian. The majority of HK are herpes simplex keratitis (HSK, 300 patients) and 96 had herpes zoster keratitis (VZV). Thirty-eight of the 403 HK patients had LSCD (9.4%). The prevalence of LSCD in HSK and VZV were 9.3% and 10.4%, respectively. Among the 38 patients with LSCD, 21 (55%) presented with stromal involvement, 15 (40%) with epithelial disease, 3 with endothelitis, 3 with uveitis, and 3 with mixed presentation. In addition, 6 of 38 LSCD patients (19%) had bilateral disease, and one (1.6%) was a pediatric patient. The prevalence of LSCD in eyes with stromal involvement was significantly higher than those without (13.3 vs. 6.9%, P=0.033).
Conclusions :
We found a 10% prevalence of LSCD among patients with a history of herpetic keratitis. Stromal involvement is associated with LSCD. Further studies are warranted to investigate the relationship between herpetic keratitis and LSCD.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.