Herpes Simplex Virus Keratitis Recurrence Rates With Topical Corticosteroid Use

Raju, Leela

Herpes Simplex Virus Keratitis Recurrence Rates With Topical Corticosteroid Use

Friday, April 25, 2014

KIOSKS (Boston Convention and Exhibition Center)

Leela Raju, MD, University of Pittsburgh, Pittsburgh, PA, USA

Deepinder K. Dhaliwal, MD, LAc, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Roheena Kamyar, MD, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Catherine M. Reppa, MD, University of North Carolina, Chapel Hill, NC, USA

Weldon Miller, MS, Univeristy of Pittsburgh, Pittsburgh, PA, USA

Mojgan Hassanlou, MD, Herzig Eye Institute, Toronto, ON, Canada

Alex Mammen, MD, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Narrative Responses:

Purpose
Corneal scarring due to HSV keratitis can lead to loss of visual acuity. While HEDS demonstrated that oral acyclovir is effective in reducing the risk of HSV recurrence, this retrospective review will attempt to identify if adding a topical corticosteroid can further reduce this risk.

Methods
A total of 135 unique patients and 111 HSV keratitis recurrences were reviewed in this retrospective cohort study. Patients visiting the UPMC Eye Center from 09/2002 to 09/2011 who were diagnosed with herpes simplex keratitis and had not received a corneal transplant were deemed eligible for the study. Statistics were carried out on SAS 9.3. A proportional hazards model and a Kaplan-Meier survival curve were used to test the effects of oral antiviral and topical corticosteroid use on the recurrence rate of HSV keratitis.

Results
The mean patient age at first presentation was 54 years old. Fifty-four out of 135 patients had a recurrence. At the time of recurrence, 40% of patients were on an oral antiviral alone, 5% were on a topical corticosteroid, 23% were on both, and 32% were on neither. Using a proportional hazards model, both oral antivirals and topical corticosteroids were estimated to reduce the risk of HSV keratitis recurrence; however, only oral antiviral use was statistically significant. When reviewing the subset of patients already taking oral antivirals, a Kaplan-Meier survival curve shows that topical corticosteroids may have some benefit (p=0.067).

Conclusion
While long-term corticosteroids have caused some concern due to their side effect profile, we believe that long-term, low-dose topical corticosteroids have a place in the prevention of recurrent HSV keratitis. Used in patients who recur despite oral antivirals, this evidence demonstrates a reduced recurrence rate. Further studies are warranted.