Purpose To describe the pattern of herpetic eye disease in a referral centre in Milan, Northern Italy. Methods Retrospective analysis of 241 consecutive patients affected by herpetic eye disease (Herpes Simplex Virus, Varicella Zoster Virus, Cytomegalovirus) seen at the Uveitis Service, San Raffaele Scientific Institute, Milan, between 2006 to 2011. Each patient underwent complete clinical ophthalmological evaluation. Data collected were: demographics, ocular involvement, type and location of uveitis, serological and instrumental investigations, antiviral treatment. Results Of the 241 patients, 144 (59.8%) were female and 97 (40.2%) male. Two hundred thirty- eight (98.8%) were Caucasian, 2 (0.8%) were Hispanic and 1 (0.4%) was Asian. Mean age was 54 years (range, 6-88 yrs). Mean age at onset of herpetic eye disease was 44 years (range, 1-82 yrs).Herpetic eye disease was unilateral in 229 (95.0%) patients and bilateral in 12 (5.0%) patients. Mean follow-up time was 13.5 months (range, 1-72 mths). Mean final visual acuity was 20/32 (range <20/400- 20/20).Long-term oral antiviral therapy was given to 177 patients (73.4%). Herpes Simplex Virus (HSV) involved 189 patients (78.4%): 185 had HSV type 1 and only 4 had HSV type 2; Varicella Zoster Virus (VZV) 45 patients (18.6%), and Cytomegalovirus (CMV) 7 patients (3.0%). Among 185 patients with HSV type 1, 96 (51.9%) had keratouveitis, 49 (26.5%) had stromal keratitis, 24 (13.0%) had epithelial keratitis, 5 (2.7%) had endothelitis, 3 (1.6%) had episcleritis, 3 (1.6%) had neurotrophic keratopathy, 3 (1.6%) had eyelid involvement and 2 (1.1%) had panuveitis. All 4 patients with HSV type 2 had Acute Retinal Necrosis (ARN). Among those with VZV, 18 (40.0%) had keratouveitis, 7 (15.6%) had epithelial keratitis, 7 (15.6%) had ARN, 6 (13.3%) had stromal keratitis, 5 (11.1%) had eyelid involvement, 1 (2.2%) had endothelitis, 1 (2.2%) had panuveitis.Among those with CMV, 5 (71.4%) had retinitis and 2 (28.6%) had hypertensive anterior uveitis. ARN was found in 11 (4.6%) patients (4 HSV type 2, 7 VZV).Recurrence of eye disease was found in 177 patients (73.4%). Of these, 152 (85.9%) were affected by HSV; 23 (13%) by VZV; 2 (1.1%) by CMV. Conclusions The majority of our patients (95%) had unilateral herpetic eye disease.HSV type 1 was the most frequent virus implicated in herpetic ocular infections: keratouveitis was its predominant clinical manifestation, followed by stromal keratitis. The second most common herpes virus was VZV: keratouveitis was its most frequent clinical presentation, then epithelial keratitis and ARN.In our study all patients with HSV type 2 presented with ARN.In the majority of patients oral antiviral medications remain the mainstay of therapy in the management of herpetic eye disease.
Pattern of Herpetic Eye Disease In A Referral Centre In Milan, Northern Italy
Miserocchi E;
2012-01-01
Abstract
Purpose To describe the pattern of herpetic eye disease in a referral centre in Milan, Northern Italy. Methods Retrospective analysis of 241 consecutive patients affected by herpetic eye disease (Herpes Simplex Virus, Varicella Zoster Virus, Cytomegalovirus) seen at the Uveitis Service, San Raffaele Scientific Institute, Milan, between 2006 to 2011. Each patient underwent complete clinical ophthalmological evaluation. Data collected were: demographics, ocular involvement, type and location of uveitis, serological and instrumental investigations, antiviral treatment. Results Of the 241 patients, 144 (59.8%) were female and 97 (40.2%) male. Two hundred thirty- eight (98.8%) were Caucasian, 2 (0.8%) were Hispanic and 1 (0.4%) was Asian. Mean age was 54 years (range, 6-88 yrs). Mean age at onset of herpetic eye disease was 44 years (range, 1-82 yrs).Herpetic eye disease was unilateral in 229 (95.0%) patients and bilateral in 12 (5.0%) patients. Mean follow-up time was 13.5 months (range, 1-72 mths). Mean final visual acuity was 20/32 (range <20/400- 20/20).Long-term oral antiviral therapy was given to 177 patients (73.4%). Herpes Simplex Virus (HSV) involved 189 patients (78.4%): 185 had HSV type 1 and only 4 had HSV type 2; Varicella Zoster Virus (VZV) 45 patients (18.6%), and Cytomegalovirus (CMV) 7 patients (3.0%). Among 185 patients with HSV type 1, 96 (51.9%) had keratouveitis, 49 (26.5%) had stromal keratitis, 24 (13.0%) had epithelial keratitis, 5 (2.7%) had endothelitis, 3 (1.6%) had episcleritis, 3 (1.6%) had neurotrophic keratopathy, 3 (1.6%) had eyelid involvement and 2 (1.1%) had panuveitis. All 4 patients with HSV type 2 had Acute Retinal Necrosis (ARN). Among those with VZV, 18 (40.0%) had keratouveitis, 7 (15.6%) had epithelial keratitis, 7 (15.6%) had ARN, 6 (13.3%) had stromal keratitis, 5 (11.1%) had eyelid involvement, 1 (2.2%) had endothelitis, 1 (2.2%) had panuveitis.Among those with CMV, 5 (71.4%) had retinitis and 2 (28.6%) had hypertensive anterior uveitis. ARN was found in 11 (4.6%) patients (4 HSV type 2, 7 VZV).Recurrence of eye disease was found in 177 patients (73.4%). Of these, 152 (85.9%) were affected by HSV; 23 (13%) by VZV; 2 (1.1%) by CMV. Conclusions The majority of our patients (95%) had unilateral herpetic eye disease.HSV type 1 was the most frequent virus implicated in herpetic ocular infections: keratouveitis was its predominant clinical manifestation, followed by stromal keratitis. The second most common herpes virus was VZV: keratouveitis was its most frequent clinical presentation, then epithelial keratitis and ARN.In our study all patients with HSV type 2 presented with ARN.In the majority of patients oral antiviral medications remain the mainstay of therapy in the management of herpetic eye disease.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
