Precipitation of herpetic stromal keratitis after collagen cross-linking for keratoconus

Potti, Sudhakar; Bagad, Parag Anil; Khatib, Nadim; Bevara, Akhil

doi:10.4103/ijo.ijo_1236_19

Cited by 5 publications

(2 citation statements)

References 3 publications

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“…Notably, other case studies also describe the activation of HSV keratitis after CXL for keratoconus [76][77][78][79]. HSV reactivation has been reported after emotional stress, trauma, and surgery, and UV-A exposure with the generation of ROS and depopulation of keratocytes is traumatic to the cornea [80].…”

Section: Viral Keratitismentioning

confidence: 99%

Use of corneal cross-linking beyond keratoconus: a systemic literature review

Achiron

Knyazer

Elhaddad

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. Methods A systemic literature review. ResultsWe reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. Conclusion Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.

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Section: Viral Keratitismentioning

confidence: 99%

Use of corneal cross-linking beyond keratoconus: a systemic literature review

Achiron

Knyazer

Elhaddad

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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“…Recurrence of HSK dendritic epithelial keratitis should be considered for following CXL in keratoconus patients with suspicious history[ 234 , 235 ]. It has been postulated that the ultraviolet radiation A light, damage to the epithelial/stroma trauma, or damage to the nerves of the cornea during the cornea cross-linking could result in recurrent HSV[ 236 , 237 ]. However, other authors have advocated for corneal cross-linking as a therapy for HSK[ 238 ].…”

Section: Recurrent Herpes Simplex Keratitis: Clinical Features and Pr...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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Herpes Simplex Keratitis Following Corneal Crosslinking for Keratoconus: A One-Year Case Series Follow-Up

Bagatin,

Radman,

Ranđelović

et al. 2024

Diagnostics

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Corneal crosslinking (CXL) is a medical procedure used to treat keratoconus. CXL works by strengthening the collagen fibers of the cornea through the application of riboflavin (vitamin B2) and ultraviolet (UV) light, which helps to stabilize the cornea and prevent further deterioration. There is a recognized risk that CXL can trigger the reactivation of dormant herpes simplex virus (HSV), leading to herpetic keratitis even in patients with no history of herpetic disease. We examined the medical history of 52 patients who underwent CXL procedures due to previously diagnosed keratoconus. We reviewed the patient’s medical histories to assess whether there was a herpes labialis infection and/or herpetic keratitis. Altogether, 52 eyes (from 52 patients) were analyzed. Of those, four (7.69%) patients were diagnosed with epithelial herpetic keratitis on the 5–8th day after surgery. All four patients had a history of herpes labialis and no prior HSV keratitis infection. Two patients developed herpetic keratitis despite prophylactic therapy with acyclovir 5 days before surgery. A positive history of HSV lip infection before CXL was present in 18/52 (34.62%). During a one-year follow-up period, no patient experienced a recurrence. Close follow-up is crucial for diagnosing herpetic keratitis after corneal crosslinking. The use of prophylactic antiviral therapy in patients who are asymptomatic and have a history of recurrent herpes labialis does not guarantee the prevention of infection.

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Precipitation of herpetic stromal keratitis after collagen cross-linking for keratoconus

Cited by 5 publications

References 3 publications

Use of corneal cross-linking beyond keratoconus: a systemic literature review

Use of corneal cross-linking beyond keratoconus: a systemic literature review

Herpes simplex keratitis: A brief clinical overview

Herpes Simplex Keratitis Following Corneal Crosslinking for Keratoconus: A One-Year Case Series Follow-Up

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