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Bulgarian Review of Ophthalmology

Herpes Simplex Virus and Endothelium

G. Yordanov, S. Murgova, Y. Yordanov


Human is the only natural host of herpes simplex virus (HSV). The infection caused by this double-strained DNA virus has various clinical forms and localizations in the eye. Most common is the corneal manifestation - keratitis and keratouveitis, which is often recurrent and results in low vision.

Purpose: To explore a localized corneal endothelial decompensation, stromal oedema, neovascularization and low vision in 􀉚 patient with recurrent HSV keratitis (more than 4 recurrences in 6 years) six months after routine, uncomplicated cataract surgery.

Material and methods: Male, 53-year-old with history of multiple recurrences of HSV keratitis, started 7 years ago, and reduced visual acuity in the right eye due to cicatricial corneal changes and complicated cataract.

Findings are documented with anterior segment photography, topography (Atlas 9000, Carl Zeis Meditec), wavefront analyzer (WASCA, Carl Zeis Meditec) and endothelial analysis (Pentacam, Oculus).

Results: Analysis of corneal topography, wavefront data, endothelial cell count and matching them with the localization of the lesion with anterior segment photography give us a possible explanation of the mechanisms leading to reduced vision in eyes with recurrent stromal keratitis.

Conclusion: Recurrent HSV keratitis may be a prerequisite for localized endothelial decompensation, increased corneal thickness (in active phase), marked cicatricial scaring in the convalescent period, corneal neovascularization after cataract surgery - reasons for permanently reduced vision altogether.

We believe that our understanding for short-term antiviral drug prophylaxis ( 800 mg per day after the acute phase of the infection )in herpetic stromal keratitis requires substantial revision. Given the remoteness in time - six months after the cataract surgery, the chance of a surgery trauma to be another triggering factor for recurrence of HSV keratitis is minimal.


Cornea; Keratitis; Herpes simplex virus (HSV); recurrence; recurrence prophylaxis

Full Text


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About The Authors

G. Yordanov
Eye clinic - VMA

S. Murgova
Eye clinic, Medical University - Pleven

Y. Yordanov
Eye clinic - Prof. St. Kirkovitch Hospital - Stara Zagora