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Utility of HSV Serology for Chronic Corneal Pathology
John Wang1, Daniel G Cherfan, Jeffrey M Goshe
1Department of Ophthalmology, UH Eye Institute, University Hospitals Cleveland Medical Center (J.W.) Cleveland, OH; University of British Columbia (D.G.C.), Vancouver, BC; and Cleveland Clinic Foundation-Cole Eye Institute (J.M.G.), Cleveland, OH.
Insights
Herpes simplex virus (HSV) serology can help exclude HSV as a cause of chronic corneal pathology when results are negative. This study found serology useful for guiding treatment decisions in patients with persistent corneal issues.
Area of Science:
- Ophthalmology
- Virology
- Immunology
Background:
- Chronic corneal pathology presents diagnostic challenges.
- Herpes simplex virus (HSV) is a potential cause of various corneal conditions.
- The utility of HSV serology in diagnosing chronic corneal pathology remains an area for investigation.
Purpose of the Study:
- To evaluate the clinical utility of herpes simplex virus (HSV) serology in patients with chronic corneal pathology of unknown etiology.
- To determine if HSV serology impacts diagnostic considerations and patient management.
Main Methods:
- Retrospective analysis of 54 patients with chronic corneal conditions (>6 weeks) where HSV was suspected and serology was performed.
- Data collected included demographics, clinical presentation, treatment, final diagnosis, and follow-up.
- Patients were categorized by clinical features such as corneal ulcer, stromal keratitis, superficial keratitis, and keratouveitis.
Main Results:
- The seroprevalence of HSV-1 and HSV-2 antibodies was 42.6% and 18.5%, respectively.
- Negative HSV serology results (48.1% of patients) directly impacted management by guiding decisions on antiviral medication.
- No patients with HSV serology were ultimately diagnosed with HSV keratitis, suggesting its utility in exclusion.
Conclusions:
- Herpes simplex virus (HSV) serology is most useful when negative, aiding in the exclusion of HSV as a cause of chronic corneal pathology.
- The findings support the use of HSV serology to refine diagnostic considerations and management strategies in ophthalmology.
- Seroprevalence in this cohort was consistent with general population studies.
Objectives:
The purpose of this study is to determine the utility of obtaining herpes simplex virus (HSV) serology for patients presenting with chronic corneal pathology of unknown etiology for which HSV is a diagnostic consideration.
Methods:
A retrospective analysis was performed of all patients presenting to one cornea specialist (J.M.G.) between August 2011 and April 2018 with a chronic (>6 weeks) corneal condition for which HSV was suspected and serology was performed. Patient demographics, clinical presentation, treatment, final diagnosis, and follow-up duration were recorded.
Results:
Fifty-four patients with a median age of 52 (range: 5-85) years were included in the study. Patients were classified by presenting clinical features as corneal ulcer (46.2%), stromal keratitis (24.1%), superficial keratitis (18.5%), or keratouveitis (11.1%). The seroprevalence of HSV-1 and HSV-2 antibodies were 42.6% and 18.5%, including 5 patients (9.3%) positive for both HSV-1 and HSV-2. Serology impacted management for all patients with negative titers (48.1%), defined as discontinuing antiviral medication, electing not to start antiviral medication, or continuing antiviral medication for a non-HSV etiology (e.g., varicella zoster keratitis). No patients with HSV serology were ultimately diagnosed with HSV keratitis. Median follow-up duration was 1.5 years (range 0.8-6.6 years).
Conclusion:
Although only useful when negative, our study confirms that serology may be useful for excluding HSV as a diagnostic consideration for patients presenting with chronic corneal pathology. The seroprevalence of HSV antibodies for our patient cohort was comparable with previous population-based studies.
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