关键词: 病毒性角膜炎, 病毒检测, 单纯疱疹病毒, EB病毒

Abstract: Objective To evaluate the viral etiology test results, clinical features and treatment of patients who were diagnosed as herpes virus keratitis in clinic. Design A retrospective case series. Participants Eighty patients (43 male, 53.8%) who were clinically diagnosed as viral keratitis involving the epithelial or stroma in Beijing Tongren Hospital from Dec. 2012 to Sep. 2014. Based on the age, the patients were classified into children group (0-16 years old, 4(5%) cases ), adult group (17-59 years old, 56 (70%) cases) and aged group ( ≥ 60 years old, 20 (25%) cases). Methods Patients’ tear was collected for virus antibody test. RT-PCR was performed to test virus in patients’ lacrimal fluid and corneal epithelial cell next to ulceration region. The data of clinical characteristics including general states of health, medical history, clinical manifestation and clinical features of keratitis and its ocular complications were collected. Epithelial ulcers were treated with antiviral treatment and promotion for corneal repair. The patients with shallow stromal ulcerion were given antiviral, anti-inflammatory and mydriatic treatments. The patients with deep ulceration were given antiviral, immunosuppressant and mydriatic treatments. The mean follow-up period was 8.5 months. Main Outcome Measures The viral etiology test results, the onset season, age, sex, ocular manifestations and treatment. Result In the 80 cases, 75(93.75%) were unilateral keratitis. The onset season was in winter for 44 cases (55.00%), in spring for 20 cases (25.00%), in autumn for 9 cases (11.25%) and in summer for 7 cases (8.75%). HSV-1 antibody was positive in lacrimal fluid of 20 cases, and 11 cases were HSV-2 antibody positive.
PCR for HSV-1 was positive in 23 cases. PCR for EBV was positive in 2 cases. PCRs for HSV-2, VZV and CMV were all nega-tive. Among the 80 cases, 32 (40%) were epithelial keratitis and 48 cases (60%) were stromal keratitis. Children group, adult group and aged group had 1, 25 and 6 cases with epithelial keratitis respectively, and 3, 31 and 14 cases with stromal keratitis respectively. The proportion of epithelial or stromal keratitis in different age group was not significantly different (χ²=1.975, P=0.43), neither in different gender group (χ²=2.20, P=0.14). Fifty-eight cases (72.5%) improved markedly after two-week treatments, manifested as reduction in corneal ulceration area, conjunctival congestion and anterior chamber reaction. The number of relapse was significantly more frequent in EBV positive patients than in HSV-1 positive patients (F=18.2065，P=0.000). Conclusions Viral keratitis was caused not
only by HSV-1, but also by EB virus. Patients infected by EB virus were more likely to relapse. The onset season was more common in winter. The incidence of viral keratitis in different gender and age group is not significantly different. (Ophthalmol CHN, 2015, 24: 123-127)

Key words: viral keratitis , virus detection , herpes simplex keratitis, EB virus