Year : 1984 | Volume
: 32 | Issue : 5 | Page : 382--384
Cryotherapy, immunotherapy and wiping in herpes keratitis
AG Mathur, Arun Elhence
Department of Ophthalmology, LLRM Medical College, Meerut, India
A G Mathur
Department of Ophthalmology, L. L.R.M. Medical College, Meerut
|How to cite this article:|
Mathur A G, Elhence A. Cryotherapy, immunotherapy and wiping in herpes keratitis.Indian J Ophthalmol 1984;32:382-384
|How to cite this URL:|
Mathur A G, Elhence A. Cryotherapy, immunotherapy and wiping in herpes keratitis. Indian J Ophthalmol [serial online] 1984 [cited 2022 Jul 1 ];32:382-384
Available from: https://www.ijo.in/text.asp?1984/32/5/382/27517
Herpes simplex keratitis is a growing menace in this country. The rise in incidence is probably because of the indiscriminate use of topical steroids and the lack of cheap, readily available and effective antiviral drugs. The practicing ophthalmologist is sometimes confronted with a situation where he has to treat a case of herpetic keratitis without antiviral agents. The present study aims to compare the efficacy of corneal wiping with cryo and chemical cauterization.
MATERIAL AND METHODS
154 cases of Herpes simplex Keratitis with purely epithetic lesions, or with minimal anterior stromal involvement attending the outpatients department were subjected to five different modalities of treatment The criterion for success of a particular method was dependant on the time in which the herpetic lesions became stain free. Post-operative pain; iridocyclitis; secondary infection and corneal opacification were noted as and when present The following methods were tried out
a) Iodine cautery with Antibiotic and atropine ointments and daily patching -50 cases.
b) Cryocauterization with antibiotic and Atropine ointments and daily patching - 20 cases.
c) Cryocauterization with autoserum drops every 2 minutes for one hour, Atropine and antibiotic ointments and daily patching - 24 cases.
d) Wiping with antibiotic and Atropine ointments and daily patchine - 30 cases.
Amongst the 154 patients, the majority (68.18%) were males. The age of the patients varied between 6 and 64 years, but 100 (64.92%) were below 30 years of age.
Only 39 (25.37%) had primary corneal involvement the remaining 115 (74.67%) had previous recurrences. A maximum of 5 recurrences were noticed in 13 cases. Morphologically 66 eyes (42.85%) had dendritic ulcers, 42 (27.27%) had punctate lesions; 18(11.97%) had areolar lesions; 15(9.74%) had linear lesions and 13 (8.44%) had stellate lesions.
An abnormally high percentage of patients (92 cases 59.44%) had used either combined or steroid drops prior to diagnosis. 35 (22.72%) had used IDU previously.
[Table 1] shows the range of healing time, the mean healing time and residual corneal opacities in each of the five groups.
Herpes simplex virus lives intracellularly in the superficial epithelial layers of the cornea. It would seem therefore that is should be amenable to different forms of treatment applied on the cornea. Potassium iodide cautery is commonly used to produce wide and ruthless destruction of infected epithelial cells (including surrounding area of epitheliolysis), if possible before stromal involvement. If this is done adequately at a sufficiently early stage, the stroma is protected and permanent damage averted. However, it is difficult to control the penetration of Iodide across the corneal epithelium in to the stroma and thus quite a few patients (74% in this study) got permanent corneal opacities. Since the destruction is comparatively widespread and not limited to the lesion itself surface epithelization is slower and healing takes longer. Apart from the inadvertent cauterization of subepithelial tissues the method also suffers from the drawbacks of post-operative pain and inability to prevent recurrence.
Cryocauterization introduced by Krawicz and carried on by a host of other workers including Amoilsi appears to have distinct advantages over chemical cautery. The rate of healing is comparatively slower because some normal epithelium is also destroyed in the process of freezing and re-epithelization has to take place over a wider area.
Amoils and Maier combined cryocauterization with topical serum therapy in the belief that the viral particles released on the surface after lysis of infected cells could be easily neutralized by antibodies within the serum. They reported near 100% results with this combination therapy.
The present study, however, shown a significant reduction in healing time when cryo is used with serum then when used alone, thus demonstrating the efficacy of serum in treating herpetic keratitis.
The only anti-viral drug available in this country is IDU which competes with thymidine for attachment to DNA and hence prevents replication (viristatic). Besides, it has poor corneal penetrability, therefore infections in deeper layers are not easily reached Apart from its comparatively poor action, it is easily degradable thus having a short half life.
Wiping is a simple and inexpensive method of debridement of the infected epithelial cells. Once infected cells are removed from the surface fresh mitosis and sliding can occur from the surrounding normal epithelial cells. The healing time could thus depend on the extent of the lesion. When antiviral agents are added to wiping the healing effect is accentuated due to simultaneous action on released viral particles and on the intracellular viral particles under the most superficial corneal layers, which have now been removed. The present study shows a significant reduction in healing time when wiping is combined with IDU than when it is used alone. The success of unconventional use of thrice a day IDU in the present series explodes the myth that IDU is effective when used at very frequent intervals. Perhaps the good exposure of infected cells after wiping allows a better action of IDU than otherwise.
The role of patching in herpetic keratitis needs to be emphasized. Patching allows faster epithelization by preventing epithelial damage due to repeated blinking. It is thought that herpetic keratitis patients have relative lowering of tear secretion hence predisposing the cornea to drying. Patching would prevent this from occurring.
A comparison of efficacy of corneal wiping, with Cryocautery Iodine Cautery and Autoserum therapy in cases of Herpetic Keratitis was carried out.
It was found that Epithelial lesions could be treated rapidly, in expensively by simple wiping of diseases portion of cornea with sterile pointed swabstick followed by application of 0.1% IDU drops and patching. There are minimal chances of residual corneal opacification with this method and since there is no need for expensive equipment it can be carried out anywhere in remotest places.
|1||Amoils and Maier., 1971. Arch. Ophthalmol. no:113.|
|2||Andrews and Cornichael.. 1930. Lancet 1: 857.|
|3||Amoils and Maier., 1973. Brit. J. Ophthalmol. 57: 809.|