MANAGEMENT OF STROMAL HERPES SIMPLEX VIRUS KERATITIS WITH EPITHELIAL ULCERATION USING OPTICAL COHERENCE TOMOGRAPHY-GENERATED CORNEAL THICKNESS MAPS
Published 2024 - 28th ESCRS Winter Meeting
Reference: P112 | Type: Submission | DOI: 10.82333/xz7e-b357
Authors: Nefeli Eleni Kounatidou* 1 , Louise Lu 2 , Sotiria Palioura 3
1Department of Ophthalmology,Universitätsklinikum Hamburg Eppendorf,Hamburg,Germany, 2*Yale University School of Medicine,New Haven,United States, 3Athens Vision Eye Institute,Athens,Greece
Purpose
To report two cases of herpes simplex virus (HSV) stromal keratitis with epithelial ulceration that were managed using optical coherence tomography (OCT)-generated
pachymetric and corneal epithelial thickness maps.
Setting
The current gold standard for the evaluation of HSV keratitis is slit-lamp biomicroscopy. However, distinguishing HSV epithelial keratitis with geographic ulceration and
neurotrophic keratopathy from active HSV stromal keratitis with epithelial ulceration based on appearance of the cornea under slit-lamp biomicroscopy alone is a challenge for
ophthalmologists and may result in inadequate treatment; subsequent scarring and decrease in vision are unavoidable consequences in such cases.
Methods
Two patients with a history of HSV keratitis with non-healing epithelial defects were referred to Athens Vision Eye Institute. Anterior segment OCT-generated pachymetric and
corneal epithelial thickness maps showed subclinical stromal edema and irregular epithelium, thus indicating diagnoses of HSV stromal keratitis with epithelial ulceration. The patients were placed on topical preservative-free dexamethasone and oral antiviral therapy. Steroid tapering was guided by pachymetric and corneal epithelial thickness maps at each follow-up visit.
Results
Both patients experienced initial healing of the epithelium and resolution of stromal inflammation. One patient had recurrence of HSV stromal keratitis with epithelial defect three
months after initial improvement, with pachymetric and corneal epithelial thickness maps indicating subclinical stromal edema. He was reintroduced to topical steroid therapy and the stromal edema and epithelial defect subsequently resolved. Both patients have had no recurrences in the past year.
Conclusion
Pachymetric and corneal epithelial thickness maps provide an objective assessment of stromal inflammation and two clinical advantages in the management of HSV
stromal keratitis with epithelial ulceration: 1) they help differentiate it from HSV epithelial keratitis with geographic ulceration as well as neurotrophic keratopathy, and 2) offer objective measurements to guide management with topical corticosteroids until resolution of stromal edema. Thus, treatment can be initiated in a timely manner and the blinding complications of HSV stromal keratitis can be avoided.