Treatment of keratitis with mixed viral-autoimmune etiology

Abstract

Purpose

to evaluate the results of treatment of keratitis with mixed viral-autoimmune etiology

Setting

The study conducted in SI " The Filatov Institute of Eye Diseases and Tissue Therapy NAMS of Ukraine"

Methods

Patient Sh.31 years old men was admitted to inpatient treatment 2 years ago with subtotal opacification of the cornea with vascularization of both eyes ( BE). Best corrected visual acuity at OU - 0.01; anamnesis - the patient has been ill since adolescence after a viral illness. Recurrent keratitis (twice a year). Examination: Schirmer test BE - 5-6mm; Norn test -6 sec; decreased corneal sensitivity. Herpetic Infection: increased IgG antibodies to Herpes virus, cytomegalovirus, nuclear antigen of the Einstein Barr virus, herpes zoster virus. PCR to CMV, HSV, EBV – negative. Antinuclear antibodies IgG - 0.29 (normal); HLA –B27 - not identified. No data on tuberculosis of the eyes were found; no data on acute infectious pathology. Consultations of dermatologist – diagnosis: Rosacea stage II. Confirmed diagnosis: Chronic herpetic infection, Rosacea. Severe dry eye desiases. Vascularized corneal opacification. Keratitis of mixed etiology (viral-autoimmune). Treatment: Anti-inflammatory (nonsteroidal anti-inflammatory drugs and glucocorticoids); antiviral (interferon alpha-2b recombinant, valacyclovir); preservative-free tear substitutes; doxycycline; cyclosporine. After 1 year of treatment, the patient's conjunctival hyperemia and corneal vascularization decreased, the corneal surface was epithelialized. Corneal opacities in the optical zone decreased significantly. BCVA increased by OD to 0.1 and by OS to 0.14. Schirmer's test has increased to 8-10 ?? , tear film breakup time increased to 9 sek. The patient continued to use preservative-free antiseptic drops, keratoprotectors, tear substitutes, cyclosporin. After 2 years of observation, the patient's corneal opacity significantly decreased. BCVA increased by OD to 0.12 and by OS to 0.3. Conclusions: It was possible to reduce the signs of the inflammatory process, improve tear production, reduce vascularization and opacification of the cornea, and improve visual acuity in a patient with severe DES, vascularized corneal opacification, keratitis of mixed etiology (viral-autoimmune) with long-term use of cyclosporine A in complex anti-inflammatory and neurotrophic treatment.