한국인 단순포진각막염 환자의 임상 분석 1212
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Figure 1. Comparison of the mean remission time between various types of herpetic keratitis, and the effect of oral acyclovir on remission time. Error bar: ±2 standard deviation. Group I: Infectious epithelial keratitis. II: Stromal keratitis. III: Endothelitis. IV: Neurotrophic keratitis. p: Independent ttest between oral acycloviradministered group and notadministered group. Table 1. Comparison of number of eyes with herpetic keratitis recurrence in 1 year and recurrence rate between various types of herpetic keratitis and the effect of oral acyclovir Oral acyclovir Mean recurrence rate (per year) No. of eye with recurrence (total number of eyes) * p Group I 0.21 3 (11) 0.604 0.37 2 (9) Group II 0.36 3 (4) 0.530 0.57 4 (7) Group III 0.86 3 (6) 0.617 0.46 4 (7) Group IV 0.63 1 (2) 0.700 0.62 1 (3) Total 0.44 10 (23) 0.581 0.48 11 (26) * Fortynine eyes with follow up over 12 months were analyzed. Group I: Infectious epithelial keratitis, II: Stromal keratitis, III: Endothelitis, IV: Neurotrophic keratitis. Oral acyclovir : oral acyclovir administered, : not administered. : Chi square between the groups with and without oral acyclovir administration. 1214
Figure 2. Recurrence of herpetic keratitis: Survival analysis by KaplanMeier test between the patients with oral acyclovir administration and without administration. Logrank test: p=0.28. Table 2. Comparison of final vision between various types of herpetic keratitis; the effect of history of previous herpetic keratitis to final vision Group I Group II Group III History of previous herpetic keratitis Final visual acuity 20/40 <20/40 1 eyes 29 3 5 4 8 Group I: Infectious epithelial keratitis, II: Stromal keratitis, III: Endothelitis. : Eyes with past history of herpetic keratitis, : Eyes without past history of herpetic keratitis. p: Fisher s exact test (between past history of herpetic keratitis and visual acuity). 4 3 5 1 8 2 p 0.002 0.121 0.038 1215
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1) Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea 2001;20:113. 2) Liesegang TJ, Melton LJ 3rd, Daly PJ, Ilstrup DM. Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982. Arch Ophthalmol 1989;107:11559. 3) Kaye S, Choudhary A. Herpes simplex keratitis. Prog Retin Eye Res 2006;25:35580. 4) The Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus. Arch Ophthalmol 1996;114:106572. 5) Margolis TP, Ostler HB. Treatment of ocular disease in eczema herpeticum. Am J Ophthalmol 1990;110:2749. 6) Schwartz GS, Holland EJ. Oral acyclovir for the management of herpes simplex virus keratitis in children. Ophthalmology 2000;107:27882. 7) Byon IS, Lee JE, Lee JS. Treatment of herpes simplex ocular disease with ganciclovir ophthalmic gel. J Korean Ophthalmol Soc 2005;46:16470. 8) Lee GU, Lee JH. Corticosteroid therapy in herpes simplex virus keratitis. J Korean Ophthalmol Soc 1986;27:4936. 9) Kim HI, Chung SK, Myong YW, Rhee SW. Clinical evaluations of recurrence after keratoplasty in herpes simplex keratitis. J Korean Ophthalmol Soc 1992;33,20915. 10) Sudesh S, Laibson PR. The impact of the herpetic eye disease studies on the management of herpes simplex virus ocular infections. Curr Opin Ophthalmol 1999;10:2303. 11) The Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. The Epithelial Keratitis Trial. Arch Ophthalmol 1997;115:70312. 12) The Herpetic Eye Disease Study Group. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med 1998;339:3006. 13) The Herpetic Eye Disease Study Group. Oral acyclovir for herpes simplex virus eye disease: effect on prevention of epithelial keratitis and stromal keratitis. Arch Ophthalmol 2000;118:10306. 14) Hong WS, Rhee SW. Clinical observation of herpes keratitis. J Korean Ophthalmol Soc 1977;18:12933. 15) Song YK, Chang HK. Clinical effect of acyclovir therapy on herpetic keratitis. J Korean Ophthalmol Soc 1989;30:35761. 16) Mathers WD, Jester JV, Lemp MA. Return of human corneal sensitivity after penetrating keratoplasty Arch Ophthalmol 1988;106:2101. 17) Matsumoto Y, Dogru M, Goto E, et al. Autologous serum application in the treatment of neurotrophic keratopathy. Ophthalmology 2004;111:111520. 18) Wilhelmus KR, Coster DJ, Donovan HC, et al. Prognosis indicators of herpetic keratitis. Analysis of a fiveyear observation period after corneal ulceration. Arch Ophthalmol 1981;99:157882. 19) Bell DM, Holman RC, PavanLangston D. Herpes Simplex keratitis: epidemiologic aspects. Ann ophthalmol 1982;14:4214 20) Darougar S, Wishart MS, Viswalingam ND. Epidemiological and clinical features of primary herpes simplex virus ocular infection. Br J Ophthalmol 1985;69:26. 21) Collum LM, BenedictSmith A, Hillary IB. Randomized doubleblind trial of acyclovir and idoxuridine in dendritic corneal ulceration. Br J Ophthalmol 1980;64:7669. 22) PavanLangston D, Lass J, Hettinger M, Udell I. Acyclovir and vidarabine in the treatment of ulcerative herpes simplex keratitis. Am J Ophthalmol 1981;92:82935. 23) Collum LM, O'Connor M, Logan P. Comparison of the efficacy and toxicity of acyclovir and of adenine arabinoside when combined with dilute betamethasone in herpetic disciform keratitis: preliminary results of a doubleblind trial. 1217
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Clinical Analysis of Herpetic Keratitis in Korea Joon Seo Hwang, M.D. 1,2, Won Ryang Wee, M.D. 1,2, Jin Hak Lee, M.D. 1,3, Mee Kum Kim, M.D. 1,2 Department of Ophthalmology, Seoul National University College of Medicine 1, Seoul, Korea Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute 2, Seoul, Korea Department of Ophthalmology, Seoul National University Bundang Hospital 3, Gyeonggi, Korea Purpose: To investigate the clinical characteristics of herpetic keratitis in Korea. Methods: A retrospective analysis was performed on 90 eyes of 84 patients who were clinically diagnosed with herpetic keratitis and were followed for at least 4 months or more. Information on prior herpetic keratitis, type of keratitis, time to remission, recurrence rate, administration of oral acyclovir, final visual acuity was reviewed. Remission time and recurrence rate were compared according to types of herpetic keratitis and the application of oral acyclovir in epithelial, stromal or endothelial keratitis; and the relation of history of previous herpetic keratitis, recurrence and final vision, was analyzed. Results: Sex ratio (M:F) was 1.31 and the mean age was 54.6 years. Of 90 eyes, the proportion of infectious epithelial keratitis, stromal keratitis, endothelitis and neurotrophic ulcer was 51.1, 17.8, 25.6 and 5.6%, respectively. The mean remission time was 1.92±1.01, 4.13±5.05, 5.52±5.08, 4.00±1.00, respectively (p=0.001, oneway Anova). Recurrence occurred in 21 (42.9%) eyes of 49, which were followed up for more than 12 months, in a year after the previous attack. The rates of recurrence of infectious epithelial keratitis, stromal keratitis and endothelitis were 25.0%, 63.6% and 53.8%, respectively. Oral acyclovir neither shortens the remission nor prevents the recurrence. The percentage of final vision over 20/40 in infectious epithelial keratitis, stromal keratitis and endothelitis was 81.1, 57.1 and 60.0%, respectively. The final vision was worse in the group with a history of herpetic keratitis. Conclusions: Stromal keratitis and endothelitis showed a higher recurrence rate and longer remission time than infectious epithelial keratitis. Because recurrent and severe keratitis may result in corneal opacity and vision loss, aggressive and proper treatment is needed. However, these cases are often resistant to therapy. J Korean Ophthalmol Soc 48(9):12121219, 2007 Key Words: Herpes simplex keratitis, Oral acyclovir, Recurrence, Visual loss, Stromal keratitis 1219