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Christopher Ryan Rosenberg, Timothy Chou, Azin Abazari, Sarah B. Weissbart; Identification of factors significantly associated with herpetic keratitis morbidity. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4901.
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© ARVO (1962-2015); The Authors (2016-present)
Few studies have investigated factors related to poor outcomes of herpetic (simplex or zoster) keratitis (HK). This retrospective study aims to identify factors that are associated with HK morbidity.
A review of patients (=128) with HSV and VZV keratitis between Mar 2013 – Nov 2019 at one institution was performed. Patients with lack of follow-up or equivocal diagnoses were excluded. Poor outcome was defined as visually significant corneal scarring, neurotrophic keratitis, secondary glaucoma, or need for corneal surgery. Secondary outcomes were the presence of chronic disease and BCVA at last follow-up. Univariate (UA) and multivariate regression (MR) analysis were used to determine the relationship between the various outcome measures and the following risk factors: age, sex, diabetes mellitus (DM), other cardiovascular disease (CV), autoimmune disease (AI), ongoing systemic immunosuppressive (IM) therapy or eyedrops, ocular procedure < 1 month prior, and prior history of ≥ 2 ocular procedures (2OP). MR was performed to adjust for potential confounders.
The 128 patients analyzed had a mean age of 59.6±SD18.9 and mean logMAR BCVA of 0.44±SD0.71 at last follow-up. Univariate chi-squared and Student t-tests revealed significant associations between poor outcome and DM (p=0.04), older age (p=0.01), 2OP (p=0.0001) and IM drops (p=0.025); between both 2OP and IM drops and neurotrophic keratitis (p=0.029 and p=0.0274, respectively), need for corneal surgery (p=0.0001 and p=0.0002, respectively), and chronic disease (p=0.045 and p=0.0031, respectively); and between all factors, except sex, AI, and systemic IM therapy, and worse logMAR BCVA at last follow-up (p<0.05). In the MR model, significant associations were maintained between DM (p=0.032) and 2OP (p=0.001) and poor outcome; and between 2OP and the need for corneal surgery (p=0.001). An association was also maintained between both DM (p=0.002) and age (p=0.043) and visually significant corneal scarring. IM drops were associated with secondary glaucoma (p=0.02). There was no difference in outcomes between simplex and zoster cases.
This study identified factors that are significantly associated with HK morbidity. DM, older age, 2OP, and ongoing IM drops at presentation may portend a poor prognosis in HK patients. Prospective studies are needed to determine the ideal treatment and prophylaxis in patients with these characteristics.
This is a 2020 ARVO Annual Meeting abstract.
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