Noninvasive Diagnosis of Viral Keratouveitis with Retro-corneal Endothelial Plaques: A Case Series

Yu, Shuo; You, De-bo; Agrawal, Rupesh; Feng, Yun

doi:10.1080/09273948.2021.1897999

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Thus, the use of imaging techniques like ASOCT plays a crucial role in the accurate and speedy diagnosis of complicated cases of viral keratitis with retrocorneal endothelial plaques. In our study, all five cases had homogeneous and regularly shaped retrocorneal plaques with clear boundaries between the corneal endothelium and the plaque, which were similar to the ASOCT findings of the plaques found in other studies with viral keratitis [ 18 , 25 ]. However, in fungal keratitis, retrocorneal endothelial plaques showed irregular shape and unclear boundary between the plaque and cornea, which implied that the fungal damage to the endothelium expands from the stroma into the anterior chamber [ 25 ].…”

Section: Discussionsupporting

confidence: 91%

“…However, in a real-world setting, diagnosis of infectious keratitis often poses significant diagnostic and therapeutic dilemmas, often due to indistinguishable clinical features shared among different causative organisms and polymicrobial infection [ 19 ]. Feathery infiltration and retrocorneal endothelial plaques are commonly associated with fungal keratitis [ 20 , 21 ]; however, in some cases, viral keratitis will mimic fugal keratitis and present with similar characteristics, which will be misdiagnosed easily and delay the treatment [ 18 , 22 ]. The inherent limitations of conventional microbiological testing such as variably low culture positivity rate and a long turnaround time are a recurrent theme in literature [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, there is a crucial need to address the tactics of diagnosis and treatment in severe cases of viral keratitis which mimic bacterial and fungal keratitis. Our previous research revealed that mild viral keratitis with retrocorneal plaques can be successfully managed with antiviral drugs and topical steroids, without surgical intervention, but the efficacy of conservative treatment is uncertain in severe cases [ 18 ]. Herein, we report our experience of conservative management of patients with severe viral keratitis with hypopyon over 3 mm and retrocorneal endothelial plaques in a cornea and tertiary referral eye care center in northern China.…”

Section: Introductionmentioning

confidence: 99%

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Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Yang

Yu²,

Zhang³

et al. 2022

Ophthalmol Ther

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Introduction Severe viral keratitis with hypopyon and retrocorneal plaques is easily misdiagnosed as it mimics fungal or bacterial keratitis and is more likely to undergo emergency therapeutic penetrating keratoplasty (TPK) in the presence of active infection, resulting in poor outcomes. This case series offers some important insights for the management strategy of severe viral keratitis. Methods This retrospective case series involved five patients with unilateral severe infectious keratitis with hypopyon over 3 mm and retrocorneal endothelial plaques. Testing for corneal sensation, microscopy, culture, and anterior segment optical coherence tomography (ASOCT) were performed. Results At presentation, all five cases had visual acuity of counting fingers (CF) or worse, large centrally located ulcer with clean ulcer surface, hypopyon, and retrocorneal plaques with reduced corneal sensation. ASOCT demonstrated the presence of retrocorneal plaques with clear space between corneal endothelium and plaques. All cases received systemic and topical ganciclovir and topical steroids. Two patients received intravenous immunoglobulin (IVIG) weekly for 2 weeks. Complete resolution was achieved in all cases except one patient who underwent TPK because of diffuse anterior synechiae of the iris, with recurrence of infection after 10 days. The patients who received IVIG showed resolution earlier compared to the other patients. Conclusions Evaluation of characteristics of retrocorneal plaques by ASOCT and reduced corneal sensation are valuable aids in diagnosis of complicated viral keratitis. Conservative medical management may be a viable option even in severe cases. IVIG may have a role in speedy resolution of severe cases, but more research is needed to confirm this. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00592-x.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Yang

Yu²,

Zhang³

et al. 2022

Ophthalmol Ther

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“…Machine learning-based multinomial regression reduced the frequency of misdiagnosing HSV anterior uveitis from other uveitis etiologies[ 110 ]. Optical coherence tomography (OCT) is useful in monitoring patients' reactions to medication therapy[ 111 , 112 ]. Soliman et al [ 113 ] described the anterior segment-OCT findings of HSK as having sub-epithelial infiltration and specific stromal hyper-reflective patterns.…”

Section: Diagnostic Approaches For Herpes Simplex Keratitis: Challeng...mentioning

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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Viral Anterior Uveitis: A Practical and Comprehensive Review of Diagnosis and Treatment

Feng,

Garcia,

Rojas-Carabali

et al. 2023

Ocular Immunology and Inflammation

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Noninvasive Diagnosis of Viral Keratouveitis with Retro-corneal Endothelial Plaques: A Case Series

Cited by 4 publications

References 18 publications

Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Herpes simplex keratitis: A brief clinical overview

Viral Anterior Uveitis: A Practical and Comprehensive Review of Diagnosis and Treatment

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