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   Table of Contents      
ORIGINAL ARTICLE
Year : 1985  |  Volume : 33  |  Issue : 1  |  Page : 9-13

Herpetic keratitis-role of cryotherapy and autogenous serum


Department of Ophthalmology and Biochemistry, Medical College, Rohtak, India

Correspondence Address:
IPS Parmar
Department of Ophthalmology, Medical College, Rohtak-124001
India
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Source of Support: None, Conflict of Interest: None


PMID: 4077215

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How to cite this article:
Parmar I, Nagpal R C, Chugh J P, Seth R K, Saini A S. Herpetic keratitis-role of cryotherapy and autogenous serum. Indian J Ophthalmol 1985;33:9-13

How to cite this URL:
Parmar I, Nagpal R C, Chugh J P, Seth R K, Saini A S. Herpetic keratitis-role of cryotherapy and autogenous serum. Indian J Ophthalmol [serial online] 1985 [cited 2019 Aug 23];33:9-13. Available from: http://www.ijo.in/text.asp?1985/33/1/9/27323



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A number of methods, including cautery debridement of epithelium by copper sulphate[1] iodine[2] and silver nitrate[3], have been devised to treat herpes simplex keratitis. Various antiviral drugs have also been found to be effective. However, very few reports are available regarding the role of cryotherapy or autogenous serum therapy in the treat­ment of herpes simplex keratitis.

Therefore, the present study evaluates the effects of cryotherapy alone and in combina­tion with autogenous serum therapy in the treatment of herpes simplex keratitis.


  Material and methods Top


30 cases of herpes simplex keratitis in the age group of 10-15 years were divided into two groups, each group comprising 15 cases.

Group I-included 15 patients of herpes simplex keratitis diagnosed clinically. 10 patients (67%) had recurrent epithelial kera­titis and 5 patients (33%) had stromal kerati­tis. All these cases were treated with cryothe­rapy alone.

Group II-included 15 patients of herpes simplex keratitis. 8 cases (53%) had recurrent epithelial keratitis and 7 cases (47%) had herpetic stromal keratitis. These patients were subjected to cryo and autogenous serum therapy.

Tear protein pattern was studied in all the cases of these two groups before and after 10 days of the treatment.

Group III-Comprised 30 cases who were selected as a control group from the out patient department. These cases did not have any eye disease and had come for a routine eye check up only.


  Cryotherapy Top


It was done with a 2 mm diameter sterile cryoprobe at a temperature of -70 to -80°C. Multiple contiguous applications lasting for 3-5 seconds were made to cover all the stained area of the corneal lesion and an adjoining margin of 1-2 mm. Thereafter a drop of 4% Xylocaine and Homatropine drops were instilled three times during the first hour. Tablet analgin (500 mg) was given to the patient to combat the pain.


  Autogenous serum therapy Top


Fresh serum was prepared from 25 ml of the patient's own blood. Immediately after cryotherapy one drop of serum was instilled at intervals of one minute each for one hour, besides other drops.


  Tear protein estimations Top


A tear sample was collected from all the patients included in the study. About 0.5 to 1 ml of tears were collected from the lateral canthus in a micropipette and then transfe­rred to a clean sterile test tube and preserved for estimation of tear protein pattern by polyacrylamide disc gel electrophoretic technique[5], total proteins[7] and tear albumin[8].


  Observations Top


Immediately after cryoapplication, the cornea appeared clear in all the cases. After 24 hours, the cornea was found to be hazy in 6 cases. This haziness lasted for 72 hours. Immediately after cryoapplication, there was no change in the staining pattern of the ulce­ration. However, after 24 hours there was a loss of 1-2 mm of epithelium surrounding the corneal ulceration, giving it an appearance of a clean edged corneal abrasion. [Table - 1][Table - 2].

On follow up over a period of 6 weeks, 2 healed cases of stromal keratitis in group I had a recurrence which was successfully treated again with cryoapplication. In group 11 also, there was a recurrence in one case of healed stromal keratitis which was also succe­ssfully retreated with cryotherapy and auto­genous serum therapy.


  Electrophoresis of tears Top


The electrophoretic mobility of the various fractions obtained in different types of herpes simplex keratitis was compared with those of human serum. This was done by scaling the total length of the space occupied by the bands (upto albumin) in each gel against an arbitrary division of 100. Each band was then identified by comparison with serum bands taken as a standard[7].

The electrophoretic band of normal serum revealed 8 bands [Figure - 1]. The protein pattern of normal tear sample revealed 5 bands [Figure - 2] while in cases of herpes simplex keratitis the number of bands was 7 [Figure - 3] before treatment and 5 after treatment [Figure - 4].


  Discussion Top


Cryotherapy is a technique of controlled destruction of biological tissues. When a localized area of tissue is exposed to extreme cold, the lining cells are injured, then shed off, and ultimately replaced first by new cells. The principle of cryotherapy is to rupture the cell resulting in release of the viruses which are washed by the tear flow and/or neutralized by the antibodies present in the tear film. Variable reports of role of the cryotherapy in herpes simplex keratitis have appeared in the literature. On one hand, Krwawicz[7], Bellows[8] and Fulhorst et a1[9],[11]reported very good results following cryoapplication of herpetic corneal lesion. On the other hand, Mcgill et al[12] reported severe stromal reaction and en­dothelial damage following cryotherapy. Average healing period reported by Krwawicz[4] was 3.44 days in superficial herpetic keratitis and 8.8 days in stromal keratitis. Our results are quite comparable with that of Krwawicz[9] except that the average healing period was a little longer in epithelial keratitis.

The combined effects of cryotherapy and autogenous serum therapy in herpes simplex keratitis proved better than cryotherapy as the average healing period of 5 85 days in superficial epithelial keratitis and 7.29 days in stromal keratitis were shorter. In our study, the average healing time was little longer as compared to that reported by Amoils and Maier[10]. This is probably due to the effect of added concentrated human gamma globulins to patient's serum by these workers. The possible mechanism of action of autogenous serum therapy in addition to cryoapplication of herpetic corneal lesion is to neutralize the viruses with specific antibodies contained in the prepared serum. The presence of specific anti-herpes antibodies has been proved by the studies of Howard and Allen[11].

A two fold increase in total tear protein was noted in cases of herpes simplex keratitis as compared to controls [Table - 3]. Similarly a two fold increase in the tear albumin concentration was observed in patients with herpes simplex keratitis compared to the control group [Table - 3]. The increase in the tear protein concentra­tion can be explained on the basis that due to corneal inflammation in herpes keratitis, the conjunctival blood vessels are also affec­ted. As a result of it the permeability of conjunctival blood vessels increases and pro­teins may leak out in tears. The increased tear protein level may also be the result of active exudation which always occurs in response to inflammation anywhere in the body.

In our study the total tear protein levels as well as tear albumin level in treated cases were found to be lower than the levels in patients of herpes simplex keratitis. However these values were still considerably higher as compared to control group [Table - 3]. It appears that the more apparent inflammatory changes of herpes simplex keratitis disappear earlier than the associated changes in the exudative and transudative processes in the conjunctival vessels.

The study of polyacrylamide disc gel electrophoretic pattern of tear proteins in cases of herpes simplex keratitis revealed demonstrable changes. The concentration and number of different tear protein bands in patients with herpes Simplex Keratitis were more close to serum bands of normal control samples. Thus there were more bands with greater intensity in cases of Group I and It than Group III. Two additional bands detected were of beta-1 lipoprotein and Gc protein. Both these bands were present in normal serum also. The intensity of gamma-globulin and albumin bands was also increased in cases of herpes keratitis and it resembled more that of corres­ponding bands in the serum. These findings indicate that there exists some definite relatio­nship between serum and tear proteins in patients of herpes simplex keratitis.

The tear protein pattern in treated cases showed only minor alterations from the tear protein pattern observed in patients of herpes keratitis. The intensity of albumin band was same in both cases while that of globulin bands was decreased in the treated cases. The albumin fraction has a lower molecular weight as compared to globulins and since the albumin fraction was still higher while globulin fraction tended to decrease in treated cases so it showed that permeability of blood vessels was still increased though it was less than in cases of active herpetic lesion. This comparatively decreased permeability allowed more transudation of lower molecular weight albumin as compared to the higher molecular weight globulins.


  Summary Top


We studied the effect of cryotherapy and autogenous serum therapy in 30 cases of recurrent herpes simplex keratitis. Tear pro­tein pattern was studied in all the cases before and after the treatment. Combined therapy (Cryo autogenous serum) proved batter than the cryotherapy alone in the treatment of herpes simplex keratitis. The total tear proteins as well as tear albumin were higher before and after the treatment of herpes simplex keratitis as compared to con­trol group.

 
  References Top

1.
Fuchs, A., 1933. Brit. J. Ophthalmol., 17: 193.  Back to cited text no. 1
    
2.
Gundersen, T., 1936 , Arch Ophthalmol., 15 :225.  Back to cited text no. 2
    
3.
Hamilton, J. B , 1943 Bit. J. Ophthalmol., 27 80.  Back to cited text no. 3
    
4.
Davis, B. J., 1964, Ann. N. Y. Acad. Sci., 12 : 404.  Back to cited text no. 4
    
5.
Lowerv, H. Rosebrough, N. J., Farr, A. L. and Randall R. J., 1951, J. Biol. Chem., 193 : 265.  Back to cited text no. 5
    
6.
Bauer, J. D . Ackarmano, P. G. and Toro, G 1974. C. V. Mosby, pp 403-404.  Back to cited text no. 6
    
7.
Krwawicz. T., 1965, Brit. J. Opbthalmol , 49 : 37.  Back to cited text no. 7
    
8.
Bellows, J. G., 1969, Canad. J. Ophthalmol., 3 :19.  Back to cited text no. 8
    
9.
Fulhorst. H. W., Richards. A. B., Bowbyes, J.and Jones. R. R. 1972, Amer. J. Ophthalmol., 73 : 47   Back to cited text no. 9
    
10.
Amoils, S. P. and Maier, G. M. G., 1971. Arch. Ophthalmol.. 86:113  Back to cited text no. 10
    
11.
Howard J. L. Allen, H. F., 1959. Arch. Ophtbalmol., 59: 6R.  Back to cited text no. 11
    
12.
Mcgill. J.. fraunfelder, F. T. and Jones, B. R. 1976. Surv. Ophthalmol. 20, 358.  Back to cited text no. 12
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

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Material and methods
Cryotherapy
Autogenous serum...
Tear protein est...
Observations
Electrophoresis ...
Discussion
Summary
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