角膜炎、角膜糜烂和溃疡患者的合并症、临床结局及单纯疱疹病毒PCR阳性率
Comorbidities, clinical outcome and rate of herpes simplex positive PCR in patients with keratitis, corneal erosions and ulcers.
作者信息
Dandachli Mhd Hosam, Maier Anna-Karina B, Hofmann Jörg, Dietrich-Ntoukas Tina
机构信息
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
Department of Ophthalmology, University Hospital Jena, Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany.
出版信息
J Ophthalmic Inflamm Infect. 2025 Aug 7;15(1):59. doi: 10.1186/s12348-025-00515-4.
INTRODUCTION
Herpes simplex keratitis (HSK) is a recurrent infection with a high risk of corneal blindness. The aim of the study is to investigate the HSV-PCR-positive smear rate, the ocular and systemic comorbidities and the impact of these comorbidities on the clinical outcome in a group of patients with pathologic corneal findings such as keratitis, persistent epithelial defects and corneal ulcers.
METHODS
In this retrospective study, we recruited 194 eyes who underwent PCR testing for HSV-1 DNA in our tertiary eye clinic from 2015 to 2021 due to suspected HSK. A poor outcome was defined as final visual acuity > 0.4 according to the Logarithm of the Minimum Angle of Resolution (LogMAR) or the need for at least one corneal surgery.
RESULTS
HSV-1-DNA was detected in 18.6% of the eyes. Corneal scarring (28.8%) and persistent epithelial defects (PED) (8.5%) were the most common complications. The highest recurrence rate (11.6%) was documented 3 months after sampling. 41.2% received systemic antiviral therapy at the first visit after collecting the sample. 75 eyes (38.7%) required at least one corneal surgery, of which amniotic membrane transplantation was the most common corneal procedure in 45 eyes (23.2%). 151 eyes (77.8%) had at least one ocular comorbidity, including previous ocular and corneal procedures (32% and 19.1% respectively) and blepharitis (26.3%). The most common systemic comorbidities were atopic diseases (10.8%), systemic immunosuppression (9.3%) and diabetes mellitus (8.8%). Previous ocular and corneal surgery, glaucoma and diabetes mellitus correlated with a poor outcome (P < 0,001). The average BCVA at the last follow-up (0.76 ± 0.83 LogMAR) was significantly better than at the time of sample collection (0.94 ± 0.76 LogMAR) (P < 0.001).
CONCLUSION
Our data confirm that HSK should be treated based on clinical findings regardless of the PCR result. We demonstrate for the first time, that comorbidities are very common and especially previous ocular and corneal surgery, glaucoma and diabetes mellitus are associated with a poor outcome. Although corneal surgery was necessary in almost 40% of the eyes during the follow-up due to a complicated course, a significant overall improvement in visual acuity was achieved compared to the initial findings.
引言
单纯疱疹病毒性角膜炎（HSK）是一种复发性感染，具有导致角膜盲的高风险。本研究的目的是调查一组有角膜炎、持续性上皮缺损和角膜溃疡等病理性角膜病变的患者中HSV-PCR阳性涂片率、眼部和全身合并症以及这些合并症对临床结局的影响。
方法
在这项回顾性研究中，我们招募了194只因疑似HSK于2015年至2021年在我们的三级眼科诊所接受HSV-1 DNA PCR检测的眼睛。根据最小分辨角对数（LogMAR），最终视力>0.4或需要至少进行一次角膜手术被定义为预后不良。
结果
18.6%的眼睛检测到HSV-1 DNA。角膜瘢痕形成（28.8%）和持续性上皮缺损（PED）（8.5%）是最常见的并发症。采样后3个月记录到最高复发率（11.6%）。41.2%的患者在采集样本后的首次就诊时接受了全身抗病毒治疗。75只眼睛（38.7%）需要至少进行一次角膜手术，其中羊膜移植是45只眼睛（23.2%）中最常见的角膜手术。151只眼睛（77.8%）有至少一种眼部合并症，包括既往眼部和角膜手术（分别为32%和19.1%）以及睑缘炎（26.3%）。最常见的全身合并症是特应性疾病（10.8%）、全身免疫抑制（9.3%）和糖尿病（8.8%）。既往眼部和角膜手术、青光眼和糖尿病与预后不良相关（P<0.001）。最后一次随访时的平均最佳矫正视力（BCVA）（0.76±0.83 LogMAR）明显优于样本采集时（0.94±0.76 LogMAR）（P<0.001）。
结论
我们的数据证实，无论PCR结果如何，HSK都应根据临床发现进行治疗。我们首次证明，合并症非常常见，尤其是既往眼部和角膜手术、青光眼和糖尿病与预后不良相关。尽管在随访期间近40%的眼睛因病程复杂需要进行角膜手术，但与初始结果相比，视力仍有显著的总体改善。
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