Cornea. 2001 Mar;20(2):123-8. doi: 10.1097/00003226-200103000-00001.
Determinants of the natural history of recurrent herpes simplex virus (HSV) keratitis have not been consistently established. We assessed how previous HSV eye disease affects the risk of recurrent HSV keratitis and evaluated whether demographic and other variables play any predictive role.
Three hundred forty-six patients in the placebo group of the Herpetic Eye Disease Study's Acyclovir Prevention Trial who had experienced an episode of HSV eye disease in the previous year were followed up for 18 months. Recurrences were categorized according to the type of involvement. Relative rates of recurrence were compared for categories of demographic variables, types and number of previous ocular HSV episodes, previous nonocular HSV infection, and month of the year.
Fifty-eight (18%) of the 346 patients developed epithelial keratitis and 59 (18%) developed stromal keratitis during the 18 months of follow-up. Previous epithelial keratitis did not significantly affect the risk of epithelial keratitis (p = 0.84). In contrast, previous stromal keratitis increased the risk of stromal keratitis 10-fold (p < 0.001), and the risk was strongly related to the number of previous episodes (p < 0.001). Age, gender, ethnicity, and nonocular herpes were not significantly associated with recurrences, and no seasonal effects were observed.
Among patients who experienced active ocular HSV disease in the previous year, a history of epithelial keratitis was not a risk factor for recurrent epithelial keratitis. In contrast, previous, especially multiple, episodes of stromal keratitis markedly increased the probability of subsequent stromal keratitis.
复发性单纯疱疹病毒（HSV）角膜炎自然病程的决定因素尚未得到一致确立。我们评估了既往HSV眼部疾病如何影响复发性HSV角膜炎的风险，并评估了人口统计学和其他变量是否起任何预测作用。
对疱疹性眼病研究阿昔洛韦预防试验安慰剂组中346例在前一年经历过一次HSV眼病发作的患者进行了18个月的随访。复发根据受累类型进行分类。比较了人口统计学变量类别、既往眼部HSV发作的类型和次数、既往非眼部HSV感染以及一年中的月份的复发相对率。
在18个月的随访期间，346例患者中有58例（18%）发生上皮性角膜炎，59例（18%）发生基质性角膜炎。既往上皮性角膜炎对上皮性角膜炎的风险没有显著影响（p = 0.84）。相比之下，既往基质性角膜炎使基质性角膜炎的风险增加了10倍（p < 0.001），且该风险与既往发作次数密切相关（p < 0.001）。年龄、性别、种族和非眼部疱疹与复发无显著相关性，未观察到季节性影响。
在前一年经历过活动性眼部HSV疾病的患者中，上皮性角膜炎病史不是复发性上皮性角膜炎的危险因素。相比之下，既往尤其是多次基质性角膜炎发作显著增加了后续基质性角膜炎的发生概率。
