Posters

Herpetic stromal keratitis: their complications and treatment results

Poster Details

First Author: A.Chekina BELARUS

Co Author(s):    T. Birich   L. Marchenko           

Abstract Details

Purpose:

To evaluate the clinical manifestations of herpetic stromal keratitis (GSK), the results of their medical and surgical treatment.

Setting:

Belarusian State Medical University, Minsk, Belarus

Methods:

GSK clinical course was studied in 73 patients. Of these, 54 patients underwent comprehensive medical therapy.Stromal forms of herpetic keratitis include: interstitial keratitis - 23 patients; distiformny - 24; necrotizing - 3; herpetic iridocyclitis - 4 patients.Of these, 54 patients underwent medical therapy: antiviral (acyclovir 1000-2000 mg per day), corticosteroids, local as subconjunctival injections and instillations;nonsteroidalanti-inflammatory drugs, protease inhibitors intravenously (trasilol, contrycal), immunotherapy (polioksidony, likopid), antihypertensive therapy, with an increase in intraocular pressure.Keratoplasty performed in 19 patients (9 deep keratoplasty; lamellar keratoplasty 11 of them in 2 -the covering lamellar keratoplasty): 7 patients - corneal ulcer with perforation and descemetocele;9 patients - intensive corneal opacity;2 patients - bullous keratopathy; 1patient - neurotrophic corneal ulcer with perforation.In 4 patients, lamellar keratoplasty was performed using an automatic microkeratome lamellar Moria.In order to reduce corneal neovascularization before keratoplasty performed laser coagulation, fine needle diathermy occlusion of corneal vessels, anti-VEGF therapy.Four patients were administered subconjunctival injections of bevacizumab (Avastin) 0.1 ml / 2.5 mg in the area of greatest vascularization.The diagnosis of herpetic infection was confirmed by detecting viral DNA by polymerase chain reaction (PCR) and specific antibodies to HSV ELISA diagnostics.

Results:

stromal keratitis increased the effectiveness of treatment. Interstitial keratitis visual acuity increased from 0.09 to 0.4, with distiformnу - from 0.04 - 0.06 to 0.6 - 0.7. Appointment of acyclovir orally (200 to 400 mg per day 5 times a day), local antiviral (virgan gel 5 times a day), local glucocorticoid, symptomatic therapy helped recovery from necrotizing herpetic keratitis for 16-18 days.Nongranulomatous herpetic iridocyclitis in 4 patients was associated with increased IOP to 35 - 50 mm Hg. Recovery with normalization of IOP was observed within 1-2 weeks upon receipt of acyclovir orally (400 mg 5 times a day) in conjunction with the local use of corticosteroids. GSK complicated forms required prolonged use of lubricants, drugs reparative regeneration, micro-doses of corticosteroids. Anti-VEGF therapy (bevacizumab(Avastin)) and antiviral therapy (acyclovir orally) helped to reduce corneal neovascularization (NV) andavoid recurrence GSK.To prevent corneal transplant rejection, recurrence of herpes infection, monitored intraocular pressure were administered orally for Acyclovir 12-18 months., topical anti-inflammatory therapy.Visual acuity postoperatively was higher in patients undergoing deep keratoplasty.Complications (synechiae, secondary glaucoma, keratouveitis, blurred transplant) at deep keratoplasty were observed more frequently than lamellarkeratoplasty (43% an 18%, respectively).

Conclusions:

Keratoplastika indicated in patients with a marked reduction vision, with stromal scarring and astigmatism in the outcome of recurrent GSK.2. After keratoplasty need long-term systemic administration of acyclovir.3. Photocoagulation, fine needle diathermy occlusion of corneal vessels, topical corticosteroids, cytotoxic agents (restasis), systemic antiviral helped reduce corneal vascularization and lipid deposits, improve visual acuity and prevent recurrence of GSK. 4. Topical bevacizumab (Avastin) therapy reduces the severity of corneal NV without local or systemic adverse effects. FINANCIAL INTEREST: NONE