July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Herpes simplex virus keratitis in a tertiary corneal subspecialty referral center in Germany – clinical features and surgical approaches
Author Affiliations & Notes
  • Raul Alfaro
    Ophthalmology, University of Saarland, Homburg, Saarland, Germany
  • Sabine Lepper
    Ophthalmology, University of Saarland, Homburg, Saarland, Germany
  • Achim Langenbucher
    Ophthalmology, University of Saarland, Homburg, Saarland, Germany
  • Nóra Szentmáry
    Ophthalmology, University of Saarland, Homburg, Saarland, Germany
  • Berthold Seitz
    Ophthalmology, University of Saarland, Homburg, Saarland, Germany
  • Footnotes
    Commercial Relationships   Raul Alfaro, None; Sabine Lepper, None; Achim Langenbucher, None; Nóra Szentmáry, None; Berthold Seitz, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6500. doi:
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      Raul Alfaro, Sabine Lepper, Achim Langenbucher, Nóra Szentmáry, Berthold Seitz; Herpes simplex virus keratitis in a tertiary corneal subspecialty referral center in Germany – clinical features and surgical approaches. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6500.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To establish a clinical database on Herpes Simplex Virus keratitis (HSK) (prevalence, clinical manifestation, required keratoplasties, follow-up and outcome) in patients attending to the Department of Ophthalmology at Saarland University Medical Center.

Methods : Retrospective (12 years), descriptive, observational study. 817 eyes with clinical diagnosis of HSK from 779 patients were analyzed. They were classified by the type of presentation from HSV eye disease. From all the patients we gathered the visual acuity, refraction, IOP, and required surgical procedures.

Results : The stromal involvement including scars represented the most common diagnosis in our department (47%), and also represented the main indication of penetrating keratoplasties (PKP). The epithelial keratitis (16%) presented with the best visual acuity at the first visit. The necrotizing keratitis represented 17% of the patients, and from them 78% required a PKP, it was also the group with the worst visual acuity at first examination and the main indication for an emergency PKP. From all the eyes a total of 288 required a PKP; the mean follow-up period was 17.5± 23 months. 230 PKP were elective procedures (90% remained clear at last follow-up) and 58 PKP were performed as emergencies procedures (55% remained clear at last follow-up). 2 patients with recurrent endotheliitis were treated with DMEK and showed good visual outcomes without HSV recurrence at last follow up.

Conclusions : The herpes simplex keratitis is a prevalent disease with severe consequences when not treated correctly and on time. The elective PKP showed better outcomes in terms of visual acuity and clear grafts percentage comparing to emergency PKP. DMEK seems to be a good option in treating recurrent endothelial keratitis with decompensation but without stromal scars.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Patient with history of recurrent herpetic keratitis episodes. Pre-operatively, avascular stromal scars BCVA 20/200.

Patient with history of recurrent herpetic keratitis episodes. Pre-operatively, avascular stromal scars BCVA 20/200.

 

Six months after excimer laser-assited penetrating keratoplasty (8.0/8.1 mm) with double running cross-stitch sutures BCVA 20/50.

Six months after excimer laser-assited penetrating keratoplasty (8.0/8.1 mm) with double running cross-stitch sutures BCVA 20/50.

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