Nemet Vedran, Matić Suzana, Zielsdorf Sarah J, Tolj Ivana, Jelić Vuković Marija, Švitek Luka, Kalauz Miro, Strunje Ivana, Matić Lucija, Heffer Marija
Department of Ophthalmology and Optometry, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.
Department of Ophthalmology, University Hospital Osijek, Osijek, Croatia.
Medicine (Baltimore). 2024 Dec 6;103(49):e40654. doi: 10.1097/MD.0000000000040654.
Herpes simplex virus 1 establishes a latent infection in trigeminal ganglia. Reactivation causes cold sores, as well as viral keratitis. The purpose of this study was to report potential benefits of using active vitamin D receptor ligands (VDR-agonists) as adjunctive therapies for the treatment of infectious corneal perforations, and prevention of HSV recurrence.
A 57-year-old female with a past history of episodic, poorly-healing, corneal erosions, recurring orolabial herpetic lesions, as well as PCR-confirmed recurrences of herpes simplex keratitis presented with a burning sensation and slight pain in the right eye. Examination indicated HSV keratitis. Topical antibiotic and oral antiviral treatments were prescribed. Despite these standard-of-care treatments, a perforated corneal ulcer ensued.
Corneal perforation associated with HSV-1 keratitis recurrence, later confirmed by PCR analysis of corneal scrapings.
Corneal perforation was treated with a human fibrin glue, fortified with multilayered amniotic membrane transplant, as well as a therapeutical contact lens. Following surgery, calcifediol and paricalcitol were started as oral adjunctive therapies in an attempt to boost tissue regeneration and innate-immunity within the slow-healing cornea. Anterior segment optical-coherence tomography was used to measure corneal thickness. Frequent follow-ups with various specialists allowed for comprehensive patient evaluation, and meticulous screening for any signs indicating potential HSV-1 recurrence.
Following calcifediol-paricalcitol therapy corneal thickening, and re-epithelization ensued. During combined calcifediol-paricalcitol therapy, the patient has had no recurrence of herpes simplex keratitis, or orolabial herpes lesions.
Corneal stabilization avoided a high-risk, full-thickness corneal transplantation, facilitating future cataract surgery, and allowing for some degree of visual recovery in this eye.
单纯疱疹病毒1型在三叉神经节建立潜伏感染。病毒再激活会引发唇疱疹以及病毒性角膜炎。本研究的目的是报告使用活性维生素D受体配体（VDR激动剂）作为辅助疗法治疗感染性角膜穿孔以及预防单纯疱疹病毒复发的潜在益处。
一名57岁女性，既往有发作性、愈合不良的角膜糜烂病史，反复出现口周疱疹性病变，以及经聚合酶链反应（PCR）确诊的单纯疱疹性角膜炎复发，右眼出现烧灼感和轻微疼痛。检查显示为单纯疱疹病毒性角膜炎。给予局部抗生素和口服抗病毒治疗。尽管进行了这些标准治疗，但仍出现了角膜穿孔性溃疡。
与单纯疱疹病毒1型角膜炎复发相关的角膜穿孔，后来通过角膜刮片的PCR分析得以证实。
采用人纤维蛋白胶治疗角膜穿孔，并辅以多层羊膜移植以及治疗性隐形眼镜。手术后，开始口服骨化二醇和帕立骨化醇作为辅助治疗，试图促进愈合缓慢的角膜组织再生和先天免疫。使用眼前节光学相干断层扫描测量角膜厚度。由多名专家进行频繁随访，以便对患者进行全面评估，并仔细筛查任何表明可能复发单纯疱疹病毒1型的迹象。
经过骨化二醇 - 帕立骨化醇治疗后，角膜增厚并重新上皮化。在联合使用骨化二醇 - 帕立骨化醇治疗期间，患者未出现单纯疱疹病毒性角膜炎复发或口周疱疹病变。
角膜稳定避免了高风险的全层角膜移植，为未来的白内障手术提供了便利，并使该眼获得了一定程度的视力恢复。
