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Herpes virus keratitis (HSK) is after cataract the second leading cause of blindness in developed countries, primarily because of its recurrent nature. There is eight known herpes viruses of which the most common cause of keratitis is HSV-1 , and it is responsible for 78% -98% of cases. Depending on the type of the affected tissue, herpetic eye disease can affect different parts of the eye. Often it affects the cornea, causing primary infection and stromal keratitis which is often repeated and leaves behind an opaque scar on the cornea with vessels.
Herpetic corneal inflammation begins on the corneal surface, on one side only, and demonstrates itself by sensitivity to light, eye tearing, redness, foreign body sensation in the eye andvision decline. Infection in the epithelium create defects of different shapes, such as dots, twigs, stars ... Later in the course of the disease the surface of the cornea heals, but residual stromal corneal opacity with vascularization rmains. If the corneal scar is in the central part of the cornea it may significantly reduce vision.
First diagnosis is made on a slit-lamp based on the clinical appearance. However, definit conclusions of the herpetic infection is based on the viral isolation from the corneal swab. In the first stage of the disease, fluorescent corneal staining will reveal typical epithelial changes in the form of branch (or some other form of epithelial defect), and at a later stage, there is a visible scar on the cornea with blood vessels.
In the treatment virostatics are applied locally and systemically, debridment, antibiotics and vitamins. In case of superficial corneal scar anterior lamellar keratoplasty may be used, while in most cases stromal corneal scar is located throughout all layers and thus penetrating corneal transplantation must be used. Our Clinic was amongst first one in Europe which started to used fortified treatment of corneal scars with anti-VEGF drugs used bost inra- and post-operatively bringing our patients to impressive 5-year corneal survival rate of over 70% (which is higher then data published in international literature).