Incidence and Risk Factors of Bilateral Herpetic Keratitis: 2022 Update

Chaloulis, Stergios K; Mousteris, Georgios; Tsaousis, Konstantinos T.

doi:10.3390/tropicalmed7060092

Cited by 17 publications

(9 citation statements)

References 53 publications

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“…By contrast, approximately 90% of Africans (in certain continental regions) develop HSV-1 keratitis by adulthood [ 2 ] . The same percentage was found in developing countries in Latin America [ 11 ] , indicating a stark contrast between developed and developing societies. Research on this topic has mostly been conducted in Western countries, leaving a knowledge gap in most parts of the world, including Kuwait and other Gulf Coast Countries (GCC) [ 12 ] , where there has been little to no research on the prevalence of herpetic keratitis [ 13 ] .…”

Section: Introductionsupporting

confidence: 53%

Frequency and visual outcomes of herpes simplex keratitis in a Kuwaiti tertiary referral center

Lotfy,

Aldhefeery,

Alenezi

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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Background: Herpes simplex virus (HSV), a cause of many ocular pathologies, may affect the corneal epithelium, stroma, or endothelium, with the epithelium as the most frequently affected location. We aimed to determine the frequency and visual outcomes of HSV keratitis over a 1-year period at Farwaniya Hospital, Kuwait. Methods: This prospective observational case series included patients diagnosed with HSV keratitis who presented to the outpatient or eye casualty department between September 2022 and September 2023. Full history, demographic profile, detailed ocular and slit-lamp examinations, and visual acuity assessments were recorded prior to and after treatment. Baseline corneal sensation was assessed in the four corneal quadrants using the cotton wisp test. Results: Of the 227 patients who presented with infectious keratitis, 72 (31.7%) were diagnosed with HSV keratitis. The mean (SD) age was 45.86 (16.06) years, and 48 (66.7%) patients were male. The subtypes of HSV keratitis were endotheliitis in 27 (37.5%) patients, dendritic ulcer in 22 (30.6%), stromal keratitis with ulceration in 9 (12.5%) and without ulceration in 8 (11.1%), and geographic ulcer in 6 (8.3%). The mean baseline best-corrected distance visual acuity (BCDVA) differed significantly between the HSV keratitis subtypes (P < 0.001). Most patients (n = 70, 97.2%) had unilateral eye involvement, were treated within 1 – 2 weeks, and demonstrated improved BCDVA. Despite the improvement in BCDVA in all HSV keratitis subtypes, a significant difference in the median BCDVA remained after treatment (P < 0.001). Pairwise comparisons revealed a significantly better BCDVA after treatment in eyes with dendritic epithelial ulcers than in eyes with HSV stromal keratitis with ulceration (P = 0.003) or geographic epithelial ulcers (P = 0.005). After treatment, corneal haze and neovascularization were detected in 54 (75.0%) and 24 (33.3%) patients, respectively. Conclusions: We detected a substantial frequency of HSV keratitis in one of the governorates of Kuwait, with endotheliitis as the most common manifestation. Timely standard treatment interventions based on valid guidelines resulted in BCDVA improvement in all subtypes of HSV keratitis in our series, indicating the importance of early treatment. However, the BCDVA in eyes with dendritic epithelial ulcers remained substantially better than that in eyes with geographic epithelial ulcers or HSV stromal keratitis with ulceration, signifying the effect of the initial HSV keratitis subtype on visual outcomes. To our knowledge, this is the first study to highlight the frequency of HSV keratitis in a Kuwaiti hospital, and larger-scale research in this region is needed to further understand and manage the condition.

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Section: Introductionsupporting

confidence: 53%

Frequency and visual outcomes of herpes simplex keratitis in a Kuwaiti tertiary referral center

Lotfy,

Aldhefeery,

Alenezi

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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“…It is the most prevalent infectious blindness-causing disease in the developed world[ 66 , 67 ], and is also prevalent in developing countries[ 68 ]. HSK commonly occurs monocularly, but can also present binocularly in certain conditions such as HIV and rheumatoid arthritis[ 69 ]. HSK has been known to affect all layers of the cornea and can be a cause of interstitial keratitis when the stroma is involved[ 70 ].…”

Section: Understanding the Pathogenesis Of Herpes Simplex Keratitismentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

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“…HSV-1 periodically reactivates and migrates anterograde in the sensory neurons to the innervated epithelial surfaces [ 225 , 226 ]. In humans, the primary corneal HSV-1 infection is rare, and most reported cases are recurrent infections because of the partial breakdown of latency [ 1 , 13 , 14 , 289 ]. Depending on the extent of HSV-1 replication, the severity of corneal cell layer damage, and the involvement of the host’s immune system, HSV-1-induced keratitis broadly can be classified as herpetic epithelial keratitis (HEK), HSK, and herpetic endothelitis [ 1 ].…”

Section: Pathogenesis Of Corneal Hsv-1 Infectionmentioning

confidence: 99%

Role of Innate Interferon Responses at the Ocular Surface in Herpes Simplex Virus-1-Induced Herpetic Stromal Keratitis

et al. 2023

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Herpes simplex virus type 1 (HSV-1) is a highly successful pathogen that primarily infects epithelial cells of the orofacial mucosa. After initial lytic replication, HSV-1 enters sensory neurons and undergoes lifelong latency in the trigeminal ganglion (TG). Reactivation from latency occurs throughout the host’s life and is more common in people with a compromised immune system. HSV-1 causes various diseases depending on the site of lytic HSV-1 replication. These include herpes labialis, herpetic stromal keratitis (HSK), meningitis, and herpes simplex encephalitis (HSE). HSK is an immunopathological condition and is usually the consequence of HSV-1 reactivation, anterograde transport to the corneal surface, lytic replication in the epithelial cells, and activation of the host’s innate and adaptive immune responses in the cornea. HSV-1 is recognized by cell surface, endosomal, and cytoplasmic pattern recognition receptors (PRRs) and activates innate immune responses that include interferons (IFNs), chemokine and cytokine production, as well as the recruitment of inflammatory cells to the site of replication. In the cornea, HSV-1 replication promotes type I (IFN-α/β) and type III (IFN-λ) IFN production. This review summarizes our current understanding of HSV-1 recognition by PRRs and innate IFN-mediated antiviral immunity during HSV-1 infection of the cornea. We also discuss the immunopathogenesis of HSK, current HSK therapeutics and challenges, proposed experimental approaches, and benefits of promoting local IFN-λ responses.

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Incidence and Risk Factors of Bilateral Herpetic Keratitis: 2022 Update

Cited by 17 publications

References 53 publications

Frequency and visual outcomes of herpes simplex keratitis in a Kuwaiti tertiary referral center

Frequency and visual outcomes of herpes simplex keratitis in a Kuwaiti tertiary referral center

Herpes simplex keratitis: A brief clinical overview

Role of Innate Interferon Responses at the Ocular Surface in Herpes Simplex Virus-1-Induced Herpetic Stromal Keratitis

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