Concomitant microbial and herpes simplex keratitis has poor ocular, visual outcomes

Ocular morbidity and visual outcomes are poor in patients with clinical presumed concomitant microbial and herpes simplex keratitis (HSK), a recent study has found.

Researchers conducted a retrospective case review of 121 patients (median age 70 years, 56 percent men) contributing a total of 126 episodes. Poor outcome was defined as: final visual acuity (VA) worse than 6/60, decrease in VA during treatment, presence of complication, or the need for surgical intervention.

Forty-six of 75 eligible episodes had poor outcome, yielding a rate of 61 percent. Patients with poor outcomes were significantly older than those with moderate and good outcomes (75 vs 66 and 47 years; p=0.005). They also presented with worse VA (p<0.001) and larger ulcers (p=0.04).

Overall, the median VA improved from 1.7 logMAR at presentation to 0.7 logMAR (p<0.05), where logMAR of 0 is equivalent to 6/6, while a logMAR of 1 is equivalent to 6/60. Twenty-five eyes had VA 6/60 or worse.

Complications arose in 70 of the 126 episodes, yielding a rate of 55 percent. Common complications included persistent epithelial defect (30 percent), intraocular pressure elevation (12 percent), and corneal perforation (10 percent).

“Clinicians in practice … are interested to know if patients with concomitant microbial keratitis and HSK are different to those with microbial keratitis alone, as this data could be used to assist diagnosis and management,” the researchers said. “Patients with poor outcomes were likely to be older, presenting with poor vision acuity and larger ulcers.”