Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution
Purpose. To identify problems contributed to the development of a chronic course of herpetic keratitis/keratouveitis and to suggest ways to solve them (taking into account the results of virological examination by PCR). Patients and methods. A group of patients (n = 90) with herpetic keratitis/kerat...
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| Format: | Article |
| Language: | Russian |
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Ophthalmology Publishing Group
2019-12-01
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| Series: | Oftalʹmologiâ |
| Subjects: | |
| Online Access: | https://www.ophthalmojournal.com/opht/article/view/1089 |
| _version_ | 1797875490336276480 |
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| author | G. M. Chernakova D. Yu. Maychuk E. A. Kleshcheva A. O. Loshkareva T. B. Semenova |
| author_facet | G. M. Chernakova D. Yu. Maychuk E. A. Kleshcheva A. O. Loshkareva T. B. Semenova |
| author_sort | G. M. Chernakova |
| collection | DOAJ |
| description | Purpose. To identify problems contributed to the development of a chronic course of herpetic keratitis/keratouveitis and to suggest ways to solve them (taking into account the results of virological examination by PCR). Patients and methods. A group of patients (n = 90) with herpetic keratitis/keratouveitis of the prolonged course was under observation. Biological secretions (tears, saliva, blood serum and urine) of patients were investigated for the presence of herpes simplex virus (HSV), varicella-zoster virus (VVZ), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), human herpesvirus type 7 (HHV-7) by polymerase chain reaction (PCR). Antiherpetic therapy included systemic oral administration of selective analogues of nucleosides (AN) — valacyclovir and phamcyclovir in daily doses of 2–3 g and 1.5 g, respectively. Local therapy included installations of mydriatic (if necessary), non-steroidal anti-inflammatory agents, antibacterial drugs. Reparative therapy consisted in prescribing conservative installations of HILOPARIN-COMOD® and PARIN-POS® ointment. Results. The clinical picture of herpetic keratitis/keratouveitis was presented by surface forms — 22 cases, deep forms — 68 cases. Positive results of HSV determination were obtained in 34.6 % of the surveyed. VZV was detected in 21 cases (28 %), CMV — in 14.6 %. EBV was detected in 28 cases (37.3 %), HHV-6 — in 37 cases (49.3 %). Genetic material of HHV-7 was found in 32 % of the examined. The results of PCR studies determined the appointment of adequate doses of nucleoside analogues (NA), which led to relief of symptoms in 100 % of cases. Active reparative therapy contributed to complete persistent epithelialization sustained by systemic use of NA in all cases within 4 weeks from the presentation. Conclusion. The results of PCR examination for the production of herpetic viruses in the tear/saliva/blood/urine are crucial to confirm the etiology of keratitis/keratouveitis, as well as determine the appointment of adequate (increased) doses of nucleoside analogues according to the recommended regimens until remission is achieved. Local therapy drugs should be used on the principle of “necessary minimum”. Therapeutic scheme for herpetic keratitis/keratouveitis already in the active stage should include local drugs with reparative effect, contributing to the achievement of persistent epithelialization. |
| first_indexed | 2024-04-10T01:47:17Z |
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| institution | Directory Open Access Journal |
| issn | 1816-5095 2500-0845 |
| language | Russian |
| last_indexed | 2024-04-10T01:47:17Z |
| publishDate | 2019-12-01 |
| publisher | Ophthalmology Publishing Group |
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| series | Oftalʹmologiâ |
| spelling | doaj.art-f5d9b1fe719147d5ab5a2fc3714a93602023-03-13T09:08:40ZrusOphthalmology Publishing GroupOftalʹmologiâ1816-50952500-08452019-12-0116453754510.18008/1816-5095-2019-4-537-545590Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to SolutionG. M. Chernakova0D. Yu. Maychuk1E. A. Kleshcheva2A. O. Loshkareva3T. B. Semenova4ФГАУ НМИЦ «МНТК “Микрохирургия глаза” им. акад. С.Н. Федорова» Министерства здравоохранения Российской Федерации, ООО «Герпетический центр» Российской академии медико‑технических наукФГАУ НМИЦ «МНТК “Микрохирургия глаза” им. акад. С.Н. Федорова» Министерства здравоохранения Российской ФедерацииФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации, ООО «Герпетический центр» Российской академии медико‑технических наукФГАУ НМИЦ «МНТК “Микрохирургия глаза” им. акад. С.Н. Федорова» Министерства здравоохранения Российской ФедерацииООО «Герпетический центр» Российской академии медико‑технических наукPurpose. To identify problems contributed to the development of a chronic course of herpetic keratitis/keratouveitis and to suggest ways to solve them (taking into account the results of virological examination by PCR). Patients and methods. A group of patients (n = 90) with herpetic keratitis/keratouveitis of the prolonged course was under observation. Biological secretions (tears, saliva, blood serum and urine) of patients were investigated for the presence of herpes simplex virus (HSV), varicella-zoster virus (VVZ), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), human herpesvirus type 7 (HHV-7) by polymerase chain reaction (PCR). Antiherpetic therapy included systemic oral administration of selective analogues of nucleosides (AN) — valacyclovir and phamcyclovir in daily doses of 2–3 g and 1.5 g, respectively. Local therapy included installations of mydriatic (if necessary), non-steroidal anti-inflammatory agents, antibacterial drugs. Reparative therapy consisted in prescribing conservative installations of HILOPARIN-COMOD® and PARIN-POS® ointment. Results. The clinical picture of herpetic keratitis/keratouveitis was presented by surface forms — 22 cases, deep forms — 68 cases. Positive results of HSV determination were obtained in 34.6 % of the surveyed. VZV was detected in 21 cases (28 %), CMV — in 14.6 %. EBV was detected in 28 cases (37.3 %), HHV-6 — in 37 cases (49.3 %). Genetic material of HHV-7 was found in 32 % of the examined. The results of PCR studies determined the appointment of adequate doses of nucleoside analogues (NA), which led to relief of symptoms in 100 % of cases. Active reparative therapy contributed to complete persistent epithelialization sustained by systemic use of NA in all cases within 4 weeks from the presentation. Conclusion. The results of PCR examination for the production of herpetic viruses in the tear/saliva/blood/urine are crucial to confirm the etiology of keratitis/keratouveitis, as well as determine the appointment of adequate (increased) doses of nucleoside analogues according to the recommended regimens until remission is achieved. Local therapy drugs should be used on the principle of “necessary minimum”. Therapeutic scheme for herpetic keratitis/keratouveitis already in the active stage should include local drugs with reparative effect, contributing to the achievement of persistent epithelialization.https://www.ophthalmojournal.com/opht/article/view/1089герпетический кератиткератоувеитгерпесвирусыпцраналоги нуклеозидов |
| spellingShingle | G. M. Chernakova D. Yu. Maychuk E. A. Kleshcheva A. O. Loshkareva T. B. Semenova Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution Oftalʹmologiâ герпетический кератит кератоувеит герпесвирусы пцр аналоги нуклеозидов |
| title | Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution |
| title_full | Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution |
| title_fullStr | Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution |
| title_full_unstemmed | Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution |
| title_short | Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution |
| title_sort | guidelines for the management of patients with herpetic keratitis keratouveitis in the long term from problem to solution |
| topic | герпетический кератит кератоувеит герпесвирусы пцр аналоги нуклеозидов |
| url | https://www.ophthalmojournal.com/opht/article/view/1089 |
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