Archipelago Keratitis From Herpetic Origin Has High Recurrence Rate

Archipelago keratitis (ApK) is a Herpesviridae infection that has a high risk of recurrence and should be treated with a combination of antiviral and anti-inflammatory drugs long-term, according to a review of clinical records published in the British Journal of Ophthalmology.

Researchers retrospectively reviewed cases of ApK treated at the Rothschild Foundation Hospital and Bicêtre-Paris Saclay University Hospital in France between 2011 and 2021. They defined recurrence as favorable evolution of a previous ApK episode and the appearance of a lesion related to ApK.

The study included 83 eyes of 82 patients (37±28 years, 60% men, 40% women) 52% of whom had a history of herpes infection. Most patients (76%) had keratitis suggestive of ApK with at least a second diagnostic criteria consistent with herpetic infection.

ApK presented unilaterally in all but a single patient. The initial lesions were central and marginal (65%), marginal alone (23%), and marginal with limbitis (12%). Lesions were located in the superior (67%), inferior (21%), nasal (6%), or temporal (6%) regions. Most eyes had diminished corneal sensitivity (63%). A fifth (20%) of patients presented with blepharitis.

Patients were given systemic antivirals (94%), topical antivirals (1%), or combined systemic and topical regimens (1%). Anti-inflammatory treatments included topical corticosteroids (44%), topical 2% ciclosporin (6%), combined corticosteroids and ciclosporin (38%), or no anti-inflammatory treatment (12%). A subset of patients also received one (10%) or more than one (18%) periocular corticosteroid injection.

More than half of the patients (53%) had an ApK recurrence at a median of 12±8 months. Recurrences presented with stromal infiltrates (48%), epithelial defects (43%), epithelial dendritic lesions (30%), epithelial ulceration (5%), limbitis (5%), and anterior uveitis (2%).

Stratified by recurrence, eyes with recurrence were at increased risk for corneal neovascularization (hazard ratio [HR], 2.1; 95% CI, 1.1-3.9; P =.02). Risk for recurrence was associated with stopping or tapering corticosteroids (HR, 3.5; 95% CI, 1.8-7.1; P <.01) or valaciclovir (HR, 2.3; 95% CI, 1.2-4.6; P =.01).

At presentation, median best-corrected visual acuity (BCVA) was 0.1 (IQR, 0-0.3) logMAR and after a median follow-up of 20.5 months, BCVA had changed little (median, 0.1; IQR, 0-0.2 logMAR).

This study was limited by its retrospective, observational design.

“The frequency of recurrence that occurred during tapering anti-inflammatory drugs in several patients suggests that inflammatory and/or immunological effectors play a key role in this rare atypical form of corneal HSK,” according to the research team.

Reference

Guindolet D, Gemahling A, Rousseau A, et al. Clinical course and treatment of archipelago keratitis: a Herpesviridae keratitis subtype. Br J Ophthalmol. Published online July 26, 2022. doi:10.1136/bjo-2021-320847