Cases reported "Keratitis, Herpetic"

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21/74. 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. ( info)

22/74. Sectorial keratitis and uveitis: differential diagnosis.

    PURPOSE. The purpose of this study was to examine the importance of considering the differential diagnosis for patients with sectorial keratitis and uveitis by case summary and literature review. methods. A retrospective review of patients with sectorial keratitis and uveitis seen at the Ocular Immunology and uveitis Service of the massachusetts eye and Ear Infirmary and a summary of the diagnoses of cases with similar ocular findings that have been reported in the literature. RESULTS. Data on six patients with sectorial keratitis and uveitis were reviewed. Four patients were female and two were male, ages 21-50 years. All were eventually diagnosed with herpes simplex viral stromal sectorial keratitis. The corneal infiltrates were most common in the superior corneal quadrants, located in the posterior corneal layers. Anterior non-granulomatous uveitis was present in all cases. One case had bilateral ocular involvement. Five of the six patients responded to topical steroids and antiviral treatment. immunomodulation with methotrexate, cyclosporine, and systemic prednisone was required in one patient. glaucoma was a complication in six of the seven eyes. Five patients developed corneal scarring, localized in the anterior and mid-stroma. CONCLUSION. The differential diagnosis of sectorial keratitis and uveitis is limited. The entities included in the differential are diverse; some of them threaten not only vision but also life. It is important for the ophthalmologist to be familiar with these entities, in order to pursue pertinent diagnostic investigations and arrive at an accurate diagnosis and institute appropriate management. ( info)

23/74. recurrence of keratitis after excimer laser keratectomy.

    We report 3 patients who experienced a recurrence of nonherpetic keratitis after excimer laser photorefractive surgery. Two patients had a history of culture-positive adenoviral keratoconjunctivitis, and 1 had a clinical diagnosis of Thygeson's superficial punctate keratitis (SPK) prior to excimer laser surgery. patients should be informed that excimer laser surgery may contribute to a recurrence of keratitis and Thygeson's SPK. Recognition and appropriate treatment can result in resolution and maintenance of a good refractive outcome. ( info)

24/74. Photodynamic therapy of corneal neovascularization with verteporfin.

    PURPOSE: To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in two patients. methods: Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months. RESULTS: Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases. CONCLUSIONS: PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required. ( info)

25/74. Transmission of herpes simplex virus infection via lacrimal canaliculi.

    We analyzed the differentiation of two strains isolated from the conjunctiva and rhinorrhea of a patient with herpetic keratitis by the restriction endonuclease digestion method of herpes simplex virus (HSV) dna. As a result two strains were identified as the same one. This result suggests that HSV contained in tears flows into the nasal cavity via the lacrimal canaliculi. ( info)

26/74. Recurrent herpetic keratitis during topical acyclovir application.

    Dendritic herpetic keratitis developed in a 49-year-old patient during topical acyclovir treatment. A positive herpes simplex culture was obtained. After acyclovir was replaced by trifluorothymidine and interferon, the dendritic lesion disappeared and herpes simplex culture became negative. Six months later a carcinoma of the larynx was diagnosed. The acyclovir-resistant herpetic keratitis may be associated with the carcinoma because resistant herpes simplex virus strains are predominantly described in patients suffering from immune deficiency. ( info)

27/74. acyclovir-resistant herpes simplex virus keratouveitis after penetrating keratoplasty.

    PURPOSE: A case of acyclovir-resistant herpes simplex virus keratouveitis after penetrating keratoplasty is reported. methods: Resistance to acyclovir was evident clinically and was confirmed by in vitro susceptibility testing. The susceptibility of the herpes simplex isolates to acyclovir and foscarnet was determined by a dye uptake assay that measured cytopathic effect, and thymidine kinase activity was measured by a plaque autoradiography technique. RESULTS: The viral isolate from postoperative day 22 was susceptible to acyclovir and foscarnet, and showed normal thymidine kinase activity. Isolates from postoperative days 29 and 32 (coinciding with deterioration in clinical appearance) were resistant to acyclovir, susceptible to foscarnet, and deficient in thymidine kinase activity. CONCLUSION: Practitioners should be aware of the potential for the emergence of resistance in this setting; prophylaxis and rational alternate therapies are discussed. ( info)

28/74. 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) ( info)

29/74. Clinical strategies for excimer laser therapeutic keratectomy.

    BACKGROUND: Surgical therapy for superficial corneal scars, dystrophies, or surface irregularities with the 193 nm excimer laser shows great promise. Depending upon the character of the pathology to be treated, different surgical strategies are required. methods: Treatment strategies for three patients with diverse corneal pathology are presented. Focal surface irregularities are treated with small laser spot sizes leaving the epithelium intact. Smooth, uniformly distributed subepithelial anterior stromal pathology is best removed with a large spot size through intact epithelium. When scattered scarring of variable thickness is present, selective epithelial debridement permits improved exposure of irregularities in Bowman's layer and the anterior stroma. RESULTS: Guidelines for selective debridement of epithelium and protection of adjacent and underlying stroma with moderate viscosity solutions enhances the surgeons's ability to obtain a smooth and clear surface while minimizing corneal thinning. Even with these strategies and use of plano disc ablation, net hyperopic shift generally occurs with broad large area therapeutic ablation. CONCLUSIONS: Superficial corneal opacities and irregularities can be surgically treated with the excimer laser as an alternative to the more invasive procedure of lamellar keratoplasty. Treatment failures can then go on to lamellar keratoplasty while successfully treated patients are more rapidly rehabilitated at lower total cost than a lamellar graft. Refinement of treatment strategies to minimize the hyperopic shift and facilitate masking around irregularities will further improve the results. ( info)

30/74. Polymicrobial keratitis secondary to burkholderia ambifaria, enterococcus, and staphylococcus aureus in a patient with herpetic stromal keratitis.

    PURPOSE: To report polymicrobial keratitis in a patient with herpetic stromal keratitis. The initial infecting organism, burkholderia ambifaria, has not previously been reported to cause microbial keratitis. methods: Clinical evaluation and corneal culture were performed. RESULTS: A 59-year-old-man undergoing topical corticosteroid therapy for herpes simplex stromal keratitis developed corneal infection with B. ambifaria. The organism was reisolated 12 days after initiation of hourly therapy with topical levofloxacin 0.5%. At reculture staphylococcus aureus and enterococcus spp. were also isolated. The addition of topical amikacin and vancomycin led to resolution of the microbial keratitis. CONCLUSIONS: burkholderia ambifaria infected a compromised cornea, exhibited an unusual sensitivity profile, and remained viable after 12 days of therapy with an antibiotic to which it was sensitive by in vitro tests. ( info)
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