Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Centre for Vision Research, Westmead Institute for Medical Research, Sydney, Australia.
Clin Exp Optom. 2021 Apr;104(3):396-405. doi: 10.1080/08164622.2021.1877531. Epub 2021 Feb 24.
Herpes Simplex Virus (HSV) is the most common virus that causes eye disease. Although around 60% of the world's population are seropositive for HSV antigens, fortunately, it is estimated that only 1% of seropositive individuals develop eye disease. The most common ocular manifestation of HSV is keratitis, while uveitis and retinal necrosis occur in a small number of cases. HSV keratitis is a debilitating disease, for several reasons: pain , photophobia, and vision loss in acute disease, latency of the virus which leads to infection reactivation from various triggers, scarring, and neovascularisation, leading to permanent vision loss with poor visual rehabilitation prospects. The Herpetic Eye Disease Study (HEDS) was a landmark series of randomised controlled trials in the 1990s that set the benchmark for evidence-based treatment guidelines for anterior eye herpetic disease. Since this time, there has been a change in the distribution of seroprevalence of herpes in the community, a simplified diagnostic classification, advances in treatment options, an emergence of new and a better understanding of risk factors, and discoveries in science that show promise for vaccine and novel future treatments. However, many of the principles of the HEDS study remain rightly entrenched in clinical practice. In this article, the HEDS study is revisited 20 years on through the lens of published literature, to determine current best practise and look towards the future.
单纯疱疹病毒（HSV）是引起眼部疾病的最常见病毒。尽管全世界约有 60%的人口对 HSV 抗原呈血清阳性，但幸运的是，据估计只有 1%的血清阳性个体患有眼部疾病。HSV 的最常见眼部表现是角膜炎，而葡萄膜炎和视网膜坏死则发生在少数病例中。HSV 角膜炎是一种使人衰弱的疾病，原因有几个：疼痛、畏光和急性疾病导致视力丧失、病毒潜伏导致各种触发因素导致感染再激活、瘢痕形成和新生血管形成，导致永久性视力丧失和视力康复前景不佳。疱疹性眼病研究（HEDS）是 20 世纪 90 年代的一系列具有里程碑意义的随机对照试验，为眼部疱疹的循证治疗指南设定了基准。自那时以来，社区中疱疹血清阳性率的分布发生了变化，诊断分类简化，治疗选择的出现，新的和更好的风险因素的出现，以及科学发现为疫苗和新型未来治疗方法带来了希望。然而，HEDS 研究的许多原则在临床实践中仍然正确地根深蒂固。在本文中，通过已发表文献的视角，回顾 HEDS 研究 20 年后，确定当前的最佳实践，并展望未来。
