Abstract
Purpose :
Herpetic interstitial keratitis (IK) caused by herpes simplex virus (HSV) or varicella zoster virus (VZV) can cause sight-threatening corneal scarring. This retrospective chart review describes the outcomes of a supervised reduction protocol (SRP) – in which topical steroids and systemic antivirals are only reduced under direct physician supervision, to ensure quiescence before further reduction – for treatment of herpetic IK.
Methods :
A cohort of 50 patients with HSV or VZV IK, all treated with SRP between September 2016 and March 2020, were included in the study. Baseline characteristics and details related to ocular outcomes were collected. The primary outcome measures were time from IK diagnosis to quiescence, time from quiescence to IK recurrence, incidence of IK recurrence, and the change in logMAR visual acuity pre-and post-treatment.
Results :
The mean follow-up period was 2.7 ± 0.8 years. Quiescence of IK was achieved within 10 weeks of treatment for 47% and 81% of patients in the HSV IK and VZV IK cohorts respectively. Recurrent IK was observed in 38.6% and 50% of patients in the HSV IK and VZV IK cohorts. The mean time from quiescence to recurrence was 170 ± 130 days in the HSV cohort and 300 ± 289 days in the VZV IK cohort. Complete cessation of topical steroids preceded recurrence of IK in 69% and 63% of patients who experienced at least one recurrence in the HSV IK and VZV IK cohorts, respectively. No statistically significant changes in logMAR visual acuity between IK diagnosis and quiescence were detected in either cohort.
Conclusions :
The time periods from herpetic IK diagnosis to quiescence and from quiescence to recurrence, as well as the rates of IK recurrence, may be helpful to clinicians attempting to determine a long-term treatment strategy for this patient population. The proportion of patients achieving quiescence within 10 weeks in the HSV IK group was higher than was seen in the seminal Herpetic Eye Disease Study (HEDS), as was the observed IK recurrence rate. The relatively high IK recurrence rates in this study may reflect increased detection of mild, pre-symptomatic IK with the SRP, due to close follow-up. Lack of change in logMAR pre- and post-treatment suggest that patients treated with SRP experienced mild, visually insignificant episodes of IK.
This is a 2021 ARVO Annual Meeting abstract.