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2018 Agenda and Abstracts | < Previous Next >

2018 OMIG Abstract

Concomitant Herpetic Keratitis and Acute Retina Necrosis

Wendy Ming, Nikhil Dewan, Sonia Yeung, Alfonso Iovieno
Department of Ophthalmology and Visual Sciences, University of British Columbia


Purpose: Herpetic keratitis and acute retinal necrosis (ARN) are both associated with the herpes family of viruses. However, there is no literature regarding the overlap of these two conditions. Our study aimed to identify risk factors, prognosis, and optimum management in patients who developed ARN in association with herpetic keratitis.

Methods: This retrospective study reviewed patient records in the Greater Vancouver Area from the last 15 years. ARN cases were identified through a search of the electronic medical records of affiliate investigators for key words and billing codes, as well as data from the pharmacy department at Vancouver General Hospital on dispensed intravitreal ganciclovir and foscarnet. The total number of herpes simplex virus (HSV), herpes zoster virus (HZV), and cytomegalovirus (CMV) keratitis cases were obtained through the ministry of healthy by searching for billing codes and ICD-9 diagnostic codes.

Results: A total of 7,190 unique patients were diagnosed with HSV/VZV/CMV keratitis during the study time. 33 patients carried a diagnosis of ARN. Out of these patients, 3 have had both ARN and herpetic keratitis. The incidence of combined herpetic keratitis and ARN was calculated to be approximately 0.04% of the total of herpetic keratitis patients, and 9% of the total of ARN patients. One of the three patients was immunocompromised. Two of the three patients developed herpetic keratitis after severe ARN, despite already being on therapeutic or prophylactic doses of antivirals. In one patient, the presentation was concomitant, and the patient developed only epithelial keratitis. In all cases, corneal findings completely resolved within three months. Two patients underwent pars plana vitrectomy for non-resolving panuveitis and received intravitreal foscarnet injections, with final visual acuity of 20/100 or worse. The third patient was treated with oral valacyclovir only, with final visual acuity of 20/20.

Conclusion: Here, we present three cases of patients with herpetic keratitis diagnosed concomitantly or following an initial diagnosis of ARN. Based on our findings, we recommend monitoring of the corneal status of all patients diagnosed with ARN, and dilated fundus examination in patients with suspected herpetic keratitis.

Disclosure: N (WM, NC, SY); C, L, O, P (AI)


2018 Agenda and Abstracts | < Previous Next >