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.
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