Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Rejeição de Enxerto/virologia , Herpes Simples/complicações , Ceratite Dendrítica/virologia , Administração Oral , Idoso , Antivirais/administração & dosagem , Feminino , Humanos , Ceratite Dendrítica/tratamento farmacológico , Ceratite Dendrítica/etiologia , Reoperação , Valaciclovir/administração & dosagemAssuntos
Dietoterapia/métodos , Ceratite Dendrítica , Ceratodermia Palmar e Plantar , Tirosina Transaminase , Tirosina/sangue , Tirosinemias , Desenvolvimento Infantil , Feminino , Humanos , Lactente , Ceratite Dendrítica/diagnóstico , Ceratite Dendrítica/etiologia , Ceratodermia Palmar e Plantar/diagnóstico , Ceratodermia Palmar e Plantar/etiologia , Mutação , Administração dos Cuidados ao Paciente/métodos , Resultado do Tratamento , Tirosina Transaminase/deficiência , Tirosina Transaminase/genética , Tirosinemias/sangue , Tirosinemias/diagnóstico , Tirosinemias/genéticaRESUMO
PURPOSE: Herpetic keratitis is a rare complication of cataract surgery. We describe 3 cases of herpes simplex keratitis after cataract surgery in eyes with no clinical history of this disease. METHODS: Three patients underwent uneventful phacoemulsification of cataract with intraocular lens implantation. All were treated postoperatively with topical steroids. On subsequent development of corneal dendritic epithelial lesions in the operated eyes, the corticosteroids were replaced by treatment with topical acyclovir. RESULTS: The first postoperative day was uneventful. Corneal dendritic epithelial lesions were observed 1-5 weeks postoperatively and healed without sequelae after topical acyclovir treatment. CONCLUSIONS: In view of the surgical trauma along with the topical corticosteroid treatment commonly prescribed after cataract surgery, physicians should be aware of the possible development of herpetic epithelial keratitis even in patients with no clinical history of this disease.
Assuntos
Ceratite Dendrítica/etiologia , Facoemulsificação/efeitos adversos , Aciclovir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Ceratite Dendrítica/tratamento farmacológico , Implante de Lente Intraocular/efeitos adversos , MasculinoRESUMO
Bilateral pseudo-dendritic keratitis in infancy can be due to tyrosinemia, a rare metabolic disorder. Ocular involvement may be the earliest presenting manifestation of this disease. Early diagnosis is essential because dietary modifications can result in complete reversal of the manifestations of this disorder. This disease must be suspected in all cases of non-responsive dendritic keratitis in the pediatric age group, especially if it is associated with cutaneous lesions such as patmoplantar keratosis. Serum tyrosine levels must be done in these cases.
Assuntos
Ceratite Dendrítica/etiologia , Tirosinemias/complicações , Diagnóstico Diferencial , Humanos , Lactente , Ceratite Dendrítica/diagnóstico , Ceratite Dendrítica/patologia , Ceratite Dendrítica/fisiopatologia , Tirosinemias/diagnóstico , Tirosinemias/dietoterapiaRESUMO
PURPOSE: To report a series of patients with no previous history of herpes simplex virus (HSV) infection who had new onset of herpetic keratitis after penetrating keratoplasty (PK). DESIGN: Noncontrolled, retrospective case series. METHODS: We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy. RESULTS: Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%). CONCLUSIONS: The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection.
Assuntos
Epitélio Corneano/virologia , Ceratite Dendrítica/etiologia , Ceratoplastia Penetrante/efeitos adversos , Aciclovir/uso terapêutico , Administração Oral , Administração Tópica , Adulto , Idoso , Antivirais/uso terapêutico , Doenças da Córnea/cirurgia , Células Epiteliais/patologia , Células Epiteliais/virologia , Epitélio Corneano/patologia , Feminino , Humanos , Ceratite Dendrítica/diagnóstico , Ceratite Dendrítica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Trifluridina/uso terapêuticoRESUMO
Five out of 430 patients (1.16%) undergoing kidney transplantation developed an atypical clinical picture of herpetic dendritic keratitis within four weeks after surgery. It was manifested by multiple dendrites, located mainly in the corneal periphery or the limbus, developing in relatively uninflamed eyes. The response to acyclovir therapy was prolonged and took at least three weeks. Additionally, subepithelial infiltrates with ultimate scarring developed in all patients. Disciform keratopathy was not found. This clinical course is ascribed to the patients' immunosuppressed state.
Assuntos
Ceratite Dendrítica/etiologia , Transplante de Rim , Complicações Pós-Operatórias/etiologia , Aciclovir/uso terapêutico , Adulto , Humanos , Terapia de Imunossupressão/efeitos adversos , Ceratite Dendrítica/tratamento farmacológico , Estudos RetrospectivosAssuntos
Abrasão Química/efeitos adversos , Infecções por Herpesviridae/etiologia , Herpesvirus Humano 4/isolamento & purificação , Ceratite Dendrítica/etiologia , Aciclovir/uso terapêutico , Idoso , Antígenos Virais/sangue , Córnea/microbiologia , DNA Viral/análise , Feminino , Infecções por Herpesviridae/tratamento farmacológico , Herpesvirus Humano 4/efeitos dos fármacos , Humanos , Ceratite Dendrítica/tratamento farmacológico , Ceratite Dendrítica/microbiologia , Reação em Cadeia da Polimerase , Acuidade VisualRESUMO
To determine if acyclovir sodium prevents postoperative herpes simplex virus type 1 (HSV-1) recurrences, 21 rabbits harboring latent HSV-1 underwent uniocular autograft penetrating keratoplasty. All operated-on eyes were treated with topical and subconjunctival dexamethasone sodium phosphate. Ten of the 21 rabbits also received oral acyclovir (intravenous acyclovir was given at the time of surgery). Postoperatively, 9 (82%) of 11 operated-on eyes in rabbits not treated with acyclovir had positive HSV-1 ocular cultures. In acyclovir-treated rabbits, however, none of the 10 operated-on eyes had positive ocular cultures. In addition, 9 (82%) of 11 of the operated-on eyes had geographic ulcers develop in the non-acyclovir-treated rabbits, compared with 1 (10%) of 10 in the acyclovir-treated rabbits. Finally, stromal keratitis appeared in 5 (56%) of 9 of the operated-on eyes in non-acyclovir-treated rabbits and 1 (12%) of 8 of the operated-on eyes in acyclovir-treated rabbits. The results of this study indicate that acyclovir significantly lowered the incidence of HSV-1 ocular shedding, geographic ulceration, and stromal keratitis in a rabbit autograft penetrating keratoplasty model.
Assuntos
Aciclovir/uso terapêutico , Transplante de Córnea , Ceratite Dendrítica/prevenção & controle , Aciclovir/administração & dosagem , Administração Oral , Animais , Substância Própria/patologia , Úlcera da Córnea/etiologia , Feminino , Injeções Intravenosas , Ceratite/etiologia , Ceratite Dendrítica/etiologia , Complicações Pós-Operatórias/prevenção & controle , Coelhos , Recidiva , Simplexvirus/isolamento & purificação , Lágrimas/microbiologiaRESUMO
We previously demonstrated that anterior chamber (AC) injection of HSV-1 before or simultaneous with topical corneal HSV-1 infection resulted in cellular immune tolerance of HSV-1 Ag and a reduced frequency of corneal stromal lesions. In the present study, we have investigated the role of the HSV-1 cell-surface glycoproteins gC and gB in the induction of tolerance, and the resulting reduced susceptibility to HSV-1 corneal stromal disease. These studies utilized mutant strains of HSV-1 with deletion or point mutations in the gene coding for gC or gB. Groups of mice received topical corneal infections with wild-type HSV-1, followed by AC injection of the same eye with wild-type HSV-1 or a mutant strain. Varying the antigenic composition of the virus injected into the AC resulted in three distinct patterns of immune responsiveness. In agreement with our previous findings, AC injection of wild-type HSV-1 induced a state of HSV-1 specific tolerance that extended to both the delayed type hypersensitivity (DTH) and CTL responses. A mutant strain lacking gC (gC-) induced partial tolerance characterized by undetectable CTL activity but a normal DTH response. A mutant strain lacking gB (gB-) caused partial suppression of the CTL response and no reduction of the DTH response. Thus, whereas gB may be involved in CTL tolerance induction in this model, gC clearly is not involved. In contrast, both gC and gB must be present in the AC to induce detectable DTH tolerance. The latter interpretation was strengthened by the observation that AC injection of a mixture of gC- (expressing normal gB) and gB- (expressing normal gC) effectively suppressed the DTH response to wild-type HSV-1. A panel of mar mutants with individual point mutations affecting gC and gB was used to identify the epitopes responsible for induction of DTH tolerance. Two of the gC mutants failed to induce DTH tolerance to wild-type HSV-1 when injected into the AC, suggesting that the sites on the gC molecule that are altered by these mutations are important for the induction of DTH tolerance. Similarly, one of the mar mutants for gB uniformly failed to suppress the DTH response, while another had a variable effect. The unique pattern of cellular immune reactivity exhibited by the mice receiving simultaneous topical corneal infection with wild-type HSV-1 and AC injection of gC- (no CTL but normal DTH) was associated with significantly reduced susceptibility to HSV-1 corneal stromal lesions.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Antígenos Virais/imunologia , Ceratite Dendrítica/imunologia , Proteínas do Envelope Viral/imunologia , Animais , Antígenos Virais/genética , Citotoxicidade Imunológica , Feminino , Hipersensibilidade Tardia/etiologia , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Tardia/microbiologia , Tolerância Imunológica , Imunidade Inata , Ceratite Dendrítica/etiologia , Ceratite Dendrítica/microbiologia , Camundongos , Camundongos Endogâmicos A , Mutação , Proteínas do Envelope Viral/genéticaAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , Segmento Anterior do Olho , Oftalmopatias/etiologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Infecções Bacterianas/etiologia , Túnica Conjuntiva/irrigação sanguínea , Conjuntivite/complicações , Infecções por Citomegalovirus/complicações , Neoplasias Palpebrais/etiologia , Mão de Obra em Saúde , Herpes Zoster Oftálmico/etiologia , Humanos , Ceratite/etiologia , Ceratite Dendrítica/etiologia , Microcirculação , Micoses/etiologia , Infecções Oportunistas/etiologia , Sarcoma de Kaposi/etiologia , Uveíte Anterior/etiologia , Doenças Vasculares/etiologiaRESUMO
Los anticuerpos séricos específicos de los virus simple (VHS) tanto de la clase IgG como IgM fueron cuantificados en un total de 52 pacientes con el diagnóstico de conjuntivitis herpética y en 66 individuos relacionados con los pacientes y clínicamente sanos. Los resultados obtenidos demuestran el pobre valor predictivo de los anticuerpos IgG anti VHS para predecir la presencia de la enfermedad, así como que la presencia de anticuerpos IgM anti VHS no está asociada a la actividad del padecimiento. Más aún, la titulación subsecuente de anticuerpos específicos anti-VHS en los pacientes no mostró correlación con la evolución clínica de l enfermedad
Assuntos
Humanos , Herpes Simples/complicações , Ceratite Dendrítica/etiologia , Anticorpos Antivirais/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Ceratite Dendrítica/imunologia , Simplexvirus/imunologiaRESUMO
Ocular involvement with acute Epstein-Barr virus infection is usually limited to a transient follicular conjunctivitis, although other lesions have been reported. Chronic Epstein-Barr virus infection has recently gained attention, but ocular manifestations have not been emphasized. We describe three patients with chronic infection with prominent ocular involvement. Bilateral uveitis was noted in all patients, ranging from an anterior uveitis that was responsive to steroids to a severe panuveitis with vitritis, cataract, optic disc swelling, and macular edema. In one patient, topical acyclovir ointment resulted in a substantial decrease in the inflammatory reaction when added to systemic acyclovir therapy. Another patient displayed a keratitis that resolved with topical steroid therapy. Cataract and vitreous surgery were also beneficial in the management of these patients.
Assuntos
Mononucleose Infecciosa/complicações , Uveíte/etiologia , Aciclovir/administração & dosagem , Aciclovir/uso terapêutico , Administração Tópica , Adolescente , Adulto , Catarata/etiologia , Extração de Catarata , Doença Crônica , Feminino , Herpesvirus Humano 4 , Humanos , Mononucleose Infecciosa/tratamento farmacológico , Ceratite Dendrítica/tratamento farmacológico , Ceratite Dendrítica/etiologia , Masculino , Uveíte/tratamento farmacológicoAssuntos
Conjuntivite Bacteriana/etiologia , Conjuntivite Viral/etiologia , Infecções por Adenovirus Humanos/etiologia , Infecções por Chlamydia/etiologia , Conjuntivite Bacteriana/epidemiologia , Conjuntivite Viral/epidemiologia , Infecções por Haemophilus/etiologia , Humanos , Japão , Ceratite Dendrítica/etiologia , Infecções Estreptocócicas/etiologiaRESUMO
Atopic dermatitis is a common skin disease associated with other allergic diatheses. Ocular complications were seen in 85 (42.5%) of 200 patients. Blepharoconjunctivitis, cataracts, corneal disease and ocular herpes simplex were frequent. Cataract surgery was usually successful, but there were complications of such surgery. The rate of success in attempts to wear contact lenses was surprisingly high for both phakic and aphakic patients.
Assuntos
Dermatite Atópica/complicações , Oftalmopatias/etiologia , Adolescente , Adulto , Catarata/etiologia , Extração de Catarata , Criança , Pré-Escolar , Conjuntivite/etiologia , Lentes de Contato , Doenças da Córnea/etiologia , Dermatite Atópica/imunologia , Doenças Palpebrais/etiologia , Feminino , Humanos , Imunoglobulina E/análise , Lactente , Ceratite Dendrítica/etiologia , Ceratocone/etiologia , MasculinoRESUMO
Three children (6 eyes) with systemic tyrosinemia who presented with a diagnosis of herpes simplex keratitis are described. Two of the patients underwent extensive treatment for herpes simplex keratitis until their defects in tyrosine metabolism were discovered. All three children responded favorably to a low-tyrosine diet. These cases illustrate the typical corneal findings of the Richner-Hanhart syndrome (pseudodendritic keratitis, hyperkeratotic skin lesions of the palms and sole without mental retardation). The findings in these three patients were similar to those cases previously reported in the literature except none had mental retardation. The ophthalmologist confronted with a young child with bilateral dendritiform keratitis should request evaluation of the serum tyrosine levels.
Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/complicações , Ceratite Dendrítica/etiologia , Ceratodermia Palmar e Plantar/complicações , Tirosina/metabolismo , Erros Inatos do Metabolismo dos Aminoácidos/dietoterapia , Feminino , Humanos , Lactente , Ceratite Dendrítica/dietoterapia , Ceratodermia Palmar e Plantar/dietoterapia , Masculino , Síndrome , Tirosina/sangueRESUMO
A 33-year-old man developed Herpesvirus hominis type 2 (HVH-2) eye disease following a herpetic lesion of the penis. The sequence of ocular involvement suggested that the virus had been transmitted endogenously from the genital lesion: granulomatous iritis was followed by interstitial keratitis and then by dendritic keratitis. Recurrent bacterial ulcers ultimately required a conjunctival flap. The course of this man's ocular disease as well as those of other reported cases of HVH-2 adult eye infections appeared to be more severe and prolonged than that of the average patient with ocular herpes type 1 infection.