Anterior Segment Optical Coherence Tomography In Herpetic Keratitis And Keratouveitis: Description Of Early Findings And Progression Of Corneal Morphology

To report and describe the corneal morphological changes, during early herpetic infection, the start of treatment and disease resolution, in order to identify possible patterns present in patients with stromal fibrosis, leucoma and poor visual outcome.

This study took place in the ophtalmology hospital: Asociación Para Evitar la Ceguera en México (APEC), Mexico City from July 17 2023 to January 12 2025. And included patients diagnosed with herpetic keratitis and keratouveitis.

A longitudinal, prospective, observational study of patients with the following inclusion criteria: patients between 18-60 years old with unilateral herpetic keratitis or keratouveitis that accepted to participate in this study, and have no history of corneal disease or surgery.

All patients who matched the criteria underwent a complete Ophthalmological evaluation, including  visual acuity, anterior segment photography and posterior segment evaluation. Anterior segment OCT and a corneal topography were acquired for the affected and control eyes, using Cirrus HD-OCT model 5000 and Schwind MS-39 spectral domain OCT and topographer. This procedure was repeated at 15 and 30 days after diagnosis.

This study included 20 patients, 11 were female (55%). The median age was 58. Four subtypes of herpetic keratitis were clinically diagnosed: epithelial (40%), stromal (10%), endothelial (20%) and keratouveitis (30%).Median anterior chamber celularity for keratouveitis was 2+.

Most common findings in SA OCT during active disease were epithelial thickening (65%) and Stromal thickening/oedema (60%). While the most common findings after disease resolution were Subepithelial hyperreflectivity (55%) and epithelial remodeling (30%). Eight patients (40%) formed a leukoma. The most common early findings in these patients were endothelial irregularity with descemet membrane folds (75%) and stromal hyperreflectivity (75%).

Most patients that developed a leukoma showed endothelial changes in the anterior segment optical coherence tomography at early stages of the infection. These characteristics could be used to dictate the timing and amount of antiinflamatory medication that should be given for each case, depending on its presentation.

When changes in the endothelium morphology are present, a more aggressive steroidal antiinflamatory regimen could be beneficial to minimize the size of the residual leukoma in patients with herpetic keratitis.