Abstract
Purpose :
Herpes simplex virus (HSV) is a leading cause of visual impairment but can be misdiagnosed in children due to its variable spectrum of presentation. In the case of an equivocal presentation, serologic testing for HSV may be one way to narrow the differential diagnosis. We sought to determine whether serologic testing for HSV, at the first visit with an ophthalmologist, impacts clinical management in children presenting with a chronic corneal or uveitic pathology.
Methods :
A retrospective cohort study of pediatric patients seen by a Vanderbilt Eye Institute (VEI) ophthalmologist between 2018-2021 for a chronic (>6 weeks) corneal or uveitic complaint was performed. All patients who underwent serologic testing for HSV at their first visit were included. Primary outcomes extracted from the electronic medical record (EMR) were the presence and type of change in clinical management following review of testing results. Change in management was defined as either: starting antiviral therapy, discontinuing empiric antiviral therapy, or continuing antiviral therapy (but excluding HSV from diagnostic consideration). The association between serologic testing result and change in management was assessed using Fisher’s exact tests and Mann-Whitney U tests.
Results :
54 patients and 83 eyes were included. Median (IQR) age was 10 (6) years old in the cornea cohort (n = 21) and 9 (4.5) years old in the uveitis cohort (n = 33). Among those with a corneal pathology, 57% of patients (n = 12) experienced a change in management, with 83% of patients discontinuing empiric antivirals following a negative result (p=0.009). Among those with uveitis, 12% of patients experienced a change in management, with only 31% of patients (n = 4) initiating antivirals following a positive result. Notably, 100% of patients with uveitis did not start antivirals following a negative result (p<0.001). The presence of classic HSV-associated findings, such as corneal dendrites, was not associated with a change in management (p=0.170).
Conclusions :
In our clinic setting, HSV blood serologic testing is associated with a change in management in patients with chronic equivocal corneal pathology but does not significantly change the clinical management of chronic uveitis. Larger studies may further elucidate the role of a negative HSV serum titer in discontinuing antiviral therapy, minimizing treatment cost, and impacting final visual outcome.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.