Clinical Profile and Treatment Outcomes of herpes Simplex Virus Keratitis at the Philippine General hospital

Background. Herpes simplex virus (HSV) keratitis is a significant cause of infectious corneal disease and visual impairment, with clinical manifestations ranging from epithelial to stromal and endothelial involvement. Despite its reported burden in the Philippines, updated local data on its clinical presentation, treatment outcomes, recurrence, and visual outcomes are limited.

Objective. The study aimed to describe the demographic profile, clinical manifestations, treatment outcomes, visual outcomes, and recurrence rates of locally diagnosed Herpes simplex virus (HSV) keratitis cases.

Methods. This cross-sectional, retrospective review examined medical records of clinically diagnosed HSV keratitis patients at the Philippine General Hospital from 2013 to 2023. Data on demographics, clinical presentation, initial and latest uncorrected distance visual acuity (UDVA), treatment outcomes, recurrence rates, and follow-up duration were collected. 

Results. Ninety-eight (98) eyes of 97 patients were included in the study. The average patient age was 47 years, with 37% in the 41 to 60-year age group. A higher predilection for males (63%) was observed. The most common clinical presentation was epithelial keratitis (26%), followed by stromal keratitis (24%), keratouveitis (22%), stromal scarring (14%), and endothelial keratitis (13%). Ninety-nine percent of cases were unilateral, and 87% presented with decreased corneal sensation. The mean time from symptom onset to consultation was 6 weeks, with an average follow-up duration of 27 months. Epithelial keratitis responded well to topical antiviral in 92% of cases. Topical steroids combined with antiviral therapy showed good responses in stromal keratitis (41%), endothelial keratitis (92%), and keratouveitis (60%). Four eyes needed tectonic penetrating keratoplasty (PKP) for corneal perforation, while 5 eyes underwent optical PKP. The overall recurrence rate was 35%, with no recurrences in patients on prophylactic oral acyclovir (ACV), compared to 33% in those without (p = 0.001). The mean uncorrected distance visual acuity (UDVA) was 1.55 ± 1.07, which significantly improved to 1.20 ± 1.14 at the latest visit (p = 0.001).

Conclusion. HSV keratitis was more common in the middle-aged group, with epithelial keratitis being the leading presentation. Early diagnosis and appropriate treatment significantly improved visual outcomes and reduced corneal complications. One-third of cases recurred, highlighting the need for long-term monitoring. Prophylactic oral ACV may reduce recurrence rates, but further research is warranted to assess its costeffectiveness.