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Anterior segment optical coherence tomography (ASOCT) as a differentiating tool between herpetic stromal keratitis and endothelitis

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Session Details

Session Title: Cornea: Medical

Session Date/Time: Tuesday 10/10/2017 | 08:00-10:30

Paper Time: 08:24

Venue: Room 3.6

First Author: : T. Agarwal INDIA

Co Author(s): :    U. Sridhar   P. Jain                 

Abstract Details


To prognosticate patients of corneal edema with prospective diagnosis of viral keratitis, by differentiating them into Herpes Simplex virus (HSV) stromal keratitis and HSV endothelitis using anterior segment optical coherence tomography as a tool.


ICARE Eye Hospital and Post Graduate Institute, Noida


25 patients presenting to the OPD with dense corneal edema were diagnosed having HSV keratitis after slit lamp examination by a cornea specialist. Anterior segment optical coherence tomography was done in all patients to assess details and differentiate patients into HSV stromal keratitis or endothelitis based on the presence of keratic precipitates on the endothelium.


13 patients were found to have endothelitis based on the presence of stromal edema with keratic precipitates on the endothelium whereas 12 patients only had stromal edema and so were diagnosed as having stromal keratitis.


Both HSV stromal keratitis and HSV endothelitis can present clinically with stromal opacity and, therefore, may be difficult to distinguish. In HSK, stromal opacity is due to immunopathology within the stroma, is often associated with corneal neovascularization, and recurrent episodes can lead to irreversible stromal scarring and vision loss. In HSV endothelitis, either secondary inflammation caused by the virus and/or direct infection of endothelial cells is thought to cause endothelial dysfunction and subsequent stromal edema and opacity. ASOCT is a useful tool to differentiate between the two. Patients with endothelitis have poorer prognosis so need aggressive treatment and close follow-up.

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