Clinical Features of Ocular Herpetic Infection in an Italian Referral Center

Purpose: The aim of this study was to describe clinical manifestations of herpetic ocular infection caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) in a referral center in Northern Italy. Methods: This retrospective study included 241 patients with herpetic ocular infection referred to the tertiary-care Ocular Immunology and Uveitis Service, at the San Raffaele Scientific Institute in Milan, from January 2006 to August 2013. The main clinical parameters evaluated were etiology, clinical features, ocular complications, and recurrences of the infection. Results: Two hundred forty-one patients (144 female and 97 male) were followed for a mean time of 24.9 +/- 18.2 months (range, 12-72). One hundred eighty-nine (78.4%) patients had HSV, 45 (18.7%) had VZV, and 7 (2.9%) had CMV infection. In the HSV and VZV groups, the most frequent manifestation was keratitis (41.3% and 31.1%, respectively), followed by anterior uveitis (33.3% and 28.9%, respectively). The most common CMV presentation was retinitis (71.4%). The main complications observed were glaucoma (38.1% in HSV group, 40% in the VZV group, and 28.6% in the CMV group) and cataract (27.5% in HSV group, 26.7% in VZV group, and 28.6% in CMV group), whereas retinal detachment frequently occurred in patients with retinitis (50%, 42.9%, and 40% among HSV, VZV, and CMV patients, respectively). Recurrences were observed in 65.1%, 51.1%, and 28.6% of patients with HSV, VZV, and CMV, respectively. Conclusions: Manifestations of herpetic ocular disease in our patients are comparable with other published series. However, the rate of ocular complications and recurrences during follow-up were higher compared with other series.