1/5. Corneal epithelial keratitis in herpes zoster ophthalmicus: "delayed" and "sine herpete". A non-contact photomicrographic in vivo study in the human cornea.PURPOSE: To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash. methods: Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. polymerase chain reaction (PCR) was done in three patients. RESULTS: Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicella-zoster virus dna in all three samples. CONCLUSIONS: The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/5. diagnosis and management of the acute retinal necrosis syndrome.The acute retinal necrosis (ARN) syndrome is an increasingly occurring entity characterized by the triad of acute confluent peripheral retinitis with papillitis and anterior-chamber uveitis. We present case reports on four patients (age, 12-65 years) with an ARN syndrome caused by herpes simplex or varicella zoster virus and discuss diagnostic and therapeutic modalities. Immediate antiviral therapy in three patients exhibiting the typical clinical features reduced the intraocular inflammation. However, due to proliferative vitreoretinopathy with peripheral retinal necrosis, vitrectomy with encircling band and silicone oil instillation was necessary in all patients. The suspected diagnosis of an ARN syndrome induced by herpes simplex virus (HSV) was confirmed in one case during the early stage of the disease by the detection of increased levels of HSV-IgA in the vitreous and in another case by the measurement of increased titers of HSV-IgG in the vitreous. For the first time, we found intraocular HSV dna sequences using the polymerase chain reaction (PCR) in one of these patients. In a fourth patient intraocular varicella zoster virus (VZV) infection was confirmed by the detection of elevated VZV-IgA levels and by positive PCR in the intraocular fluids. Two patients who were diagnosed and treated early retained a visual acuity of 0.4 and 0.5, respectively, whereas in the other two patients, whose diagnosis and therapy were delayed (> 6 weeks), visual acuity was reduced to light perception. We conclude that use of the PCR in the intraocular fluids together with detection of autochthonous antibodies in the vitreous seem to be the most important diagnostic laboratory tools.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = varicella (Clic here for more details about this article) |
3/5. Corneal surface changes in Thygeson's superficial punctate keratitis: a clinical and non-contact photomicrographic in vivo study in the human cornea.PURPOSE: To elucidate mechanisms behind the morphology of Thygeson's superficial punctate keratitis (TSPK). methods: Sixteen patients were examined with the slit lamp and photographed by non-contact photomicrography. The results were compared with morphology of epithelial keratitis in herpes simplex type 1 (HSV1), varicella zoster (VZV), and adenovirus type 8 (Ad8) infections, all previously studied by the same method, and with published histologic findings in TSPK. RESULTS: In the photographs, the corneal epithelium showed various numbers of abnormal subsurface cells measuring about 10-15 microm in diameter, present individually, in small groups, or aggregated in larger lesions (coarse lesions with the slit lamp). The surface epithelium was well preserved, except in larger lesions, which showed surface debris. The morphology was unlike HSV1 and VZV epithelial keratitis, but strongly resembled epithelial changes occurring in Ad8 infections on day 5, and later, after the onset of symptoms. CONCLUSIONS: TSPK shows a more widespread epithelial involvement than suspected with the slit lamp. Its morphology seems to reflect an action of a noxious agent targeted at the deeper epithelial layers, with the appearance of abnormal cells as a result. These might represent invading inflammatory cells, damaged intraepithelial ones, or both. The coarse lesions visualize areas of major involvement showing discernible signs of cell destruction. The similarity to Ad8 keratitis suggests that the source of the noxious agent might be located outside the cornea. The morphology, in conjunction with clinical features, is compatible with an immunologically mediated injury. The etiology remains unknown.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
4/5. herpes simplex uveitis.BACKGROUND: uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. methods: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
5/5. Possible role of herpes simplex virus in the origin of Posner-Schlossman syndrome.PURPOSE/methods: We conducted this study to determine if the herpesviruses are possible etiologic agents in Posner-Schlossman syndrome. We aspirated aqueous humor samples from patients during acute attacks of the syndrome. Ten normal aqueous humor specimens from patients undergoing cataract surgery were used as controls. dna was extracted and subjected to polymerase chain reaction amplification and Southern blot hybridization. RESULTS/CONCLUSION: All three specimens were positive for amplified genomic fragments of herpes simplex virus and negative for varicella-zoster virus and cytomegalovirus. Ten normal aqueous specimens were negative for all three. herpes simplex virus may play a role in the origin of Posner-Schlossman syndrome.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |