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New Therapeutic Perceptions in a Patient with Complicated Herpes Simplex Virus 1 Keratitis: A Case Report and Review of the Literature.

Abstract BACKGROUND Keratitis caused by herpes simplex virus (HSV) can have detrimental effects on the cornea leading to loss of vision. Modern therapies can contribute to the prevention of anatomical and functional damage. CASE REPORT An 80-year-old male with complicated HSV-1 keratitis of the left eye (confirmed diagnosis after microbiological investigation) presented three months after antiviral treatment with corneal blurring, severe epitheliopathy, thinning of the stroma, and neovascularization. At the time he was referred, the visual acuity of his left eye was very low, as he could only count fingers at a one-foot distance. He was initially started on oral acyclovir (800 mg once daily) and topical poly-carboxymethyl glucose sulfate; afterwards he underwent amniotic membrane (AM) transplantation and localized treatment with anti-VEGF factors. One month after the AM transplantation there was an obvious improvement of the corneal surface. Ophthalmic suspension of cyclosporine-A 1% was also added to his treatment. After three months, a transplantation of stem cells (deriving from the sclerocorneal junction of his right eye) was carried out at the sclerocorneal junction, as the corneal damage and neovascularization was more severe at this anatomical area. Four months after the last surgery, his visual acuity was 1/10 (note, he had a history of an old vascular episode) and the cornea was sufficiently clear with no signs of epitheliopathy and almost complete subsidence of the neovascularization. CONCLUSIONS Transplantation of AM and stem cells in combination with anti-VEGF factors and topical administration of cyclosporine-A 1% and poly-carboxymethyl glucose sulfate (a regenerative factor of corneal matrix) contributed substantially in the management of herpetic keratitis complications.
PMID
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Authors

Mayor MeshTerms

Stem Cell Transplantation

Keywords
Journal Title the american journal of case reports
Publication Year Start




 
PMID- 29279602
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180109
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 18
DP  - 2017 Dec 27
TI  - New Therapeutic Perceptions in a Patient with Complicated Herpes Simplex Virus 1 
      Keratitis: A Case Report and Review of the Literature.
PG  - 1382-1389
AB  - BACKGROUND Keratitis caused by herpes simplex virus (HSV) can have detrimental
      effects on the cornea leading to loss of vision. Modern therapies can contribute 
      to the prevention of anatomical and functional damage. CASE REPORT An 80-year-old
      male with complicated HSV-1 keratitis of the left eye (confirmed diagnosis after 
      microbiological investigation) presented three months after antiviral treatment
      with corneal blurring, severe epitheliopathy, thinning of the stroma, and
      neovascularization. At the time he was referred, the visual acuity of his left
      eye was very low, as he could only count fingers at a one-foot distance. He was
      initially started on oral acyclovir (800 mg once daily) and topical
      poly-carboxymethyl glucose sulfate; afterwards he underwent amniotic membrane
      (AM) transplantation and localized treatment with anti-VEGF factors. One month
      after the AM transplantation there was an obvious improvement of the corneal
      surface. Ophthalmic suspension of cyclosporine-A 1% was also added to his
      treatment. After three months, a transplantation of stem cells (deriving from the
      sclerocorneal junction of his right eye) was carried out at the sclerocorneal
      junction, as the corneal damage and neovascularization was more severe at this
      anatomical area. Four months after the last surgery, his visual acuity was 1/10
      (note, he had a history of an old vascular episode) and the cornea was
      sufficiently clear with no signs of epitheliopathy and almost complete subsidence
      of the neovascularization. CONCLUSIONS Transplantation of AM and stem cells in
      combination with anti-VEGF factors and topical administration of cyclosporine-A
      1% and poly-carboxymethyl glucose sulfate (a regenerative factor of corneal
      matrix) contributed substantially in the management of herpetic keratitis
      complications.
FAU - Kalogeropoulos, Dimitrios
AU  - Kalogeropoulos D
AD  - Department of Ophthalmology, Faculty of Medicine, School of Health Sciences,
      University of Ioannina, Ioannina, Greece.
FAU - Geka, Aliki
AU  - Geka A
AD  - Department of Ophthalmology, Olympion Private Hospital, Patras, Greece.
FAU - Malamos, Konstantinos
AU  - Malamos K
AD  - Department of Ophthalmology, Faculty of Medicine, School of Health Sciences,
      University of Ioannina, Ioannina, Greece.
FAU - Kanari, Maria
AU  - Kanari M
AD  - Department of Ophthalmology, Faculty of Medicine, School of Health Sciences,
      University of Ioannina, Ioannina, Greece.
FAU - Kalogeropoulos, Chris
AU  - Kalogeropoulos C
AD  - Department of Ophthalmology, Faculty of Medicine, School of Health Sciences,
      University of Ioannina, Ioannina, Greece.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20171227
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Antiviral Agents)
SB  - IM
MH  - Aged, 80 and over
MH  - Amnion/*transplantation
MH  - Antiviral Agents/therapeutic use
MH  - Herpesvirus 1, Human
MH  - Humans
MH  - Keratitis, Herpetic/*therapy
MH  - Male
MH  - *Stem Cell Transplantation
MH  - Visual Acuity
PMC - PMC5753617
EDAT- 2017/12/28 06:00
MHDA- 2018/01/05 06:00
CRDT- 2017/12/28 06:00
PHST- 2017/12/28 06:00 [entrez]
PHST- 2017/12/28 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - 906506 [pii]
PST - epublish
SO  - Am J Case Rep. 2017 Dec 27;18:1382-1389.