Abstract
Purpose :
Herpetic keratitis and acute retinal necrosis (ARN) are both associated with the herpes family of viruses. However, there is no literature regarding the overlap of these two conditions. Our study aimed to identify risk factors, prognosis, and management in patients who developed ARN and herpetic keratitis.
Methods :
This retrospective study included patient records in the Greater Vancouver Area from 2004 to 2018. ARN cases were identified through searching the electronic medical records of affiliate researchers for key words and billing codes, as well as data from the pharmacy at Vancouver General Hospital on dispensed intravitreal ganciclovir and foscarnet. The total number of herpes simplex virus (HSV) and herpes zoster virus (HZV) keratitis cases were obtained through the Ministry of Healthy through billing and ICD-9 diagnostic codes.
Results :
7,190 patients were diagnosed with herpetic keratitis during the study period. 28 patients carried a diagnosis of ARN. Of these, five had both ARN and herpetic keratitis, including one eye of the only patient with bilateral disease. The incidence of combined keratitis and ARN was approximately 0.07% of the herpetic keratitis patients, and 18% of the ARN patients.
The five patients with both diseases had a mean age of 55 ± 17 years. Two were immunocompromised due to renal transplants. Three developed zoster-related diseases in the month leading up to their diagnosis of herpes zoster ophthalmicus. Four were diagnosed with both conditions within one week. One developed keratitis a year after the initial diagnosis of ARN, during an episode of worsening posterior chamber inflammation. In all cases, corneal findings resolved within three months. All patients received systemic antiviral treatment (two initially intravenously, and the rest entirely orally), and four also received intravitreal foscarnet. Two patients developed retinal detachments requiring pars plana vitrectomy. Other complications of ARN included cystoid macular edema, epiretinal membranes, and glaucoma. Initial and final visual acuities between patients with both conditions versus ARN alone did not differ significantly (initial: logMAR 1.03 vs. 1.11; final: logMAR 1.25 vs. 1.18; p > 0.05).
Conclusions :
We present five cases of herpetic keratitis with concomitant ARN. Based on our findings, we recommend careful corneal exams in patients diagnosed with ARN, and dilated fundus exams in those with herpetic keratitis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.