Glaucoma in Viral Keratouveitis: A Retrospective Review at a Tertiary Eye Hospital

Abstract

Viral keratouveitis (VKU) could be visually debilitating owing to the intraocular inflammation causing collateral damage to the cornea and secondary elevation of intraocular pressure (IOP). In this retrospective, single-center, observational study, we analyze the clinical features and management options for VKU, with a brief review on incidence of glaucoma and its treatment outcomes. We reviewed the outpatient records at our tertiary hospital from 2015 to 2020 and found 53 eyes of 55 patients diagnosed as VKU. The main outcome measures were incidence of clinical signs, elevated IOP and glaucoma, and treatment modalities used. Sixty-four percent were males with a mean age of onset being 45.4 years. Eighty percent of the eyes were clinically diagnosed to have herpes simplex virus (HSV), 16% herpes zoster virus (HZV) and 4% cytomegalovirus (CMV). Ocular presentations most commonly noted were keratic precipitates (70.4%), corneal edema (66.7%). Associated elevation of IOP was seen in 24 eyes (44%), while glaucomatous damage was seen in 20% of the eyes. Those with fewer uveitic episodes (less than two), as opposed to those having more than two episodes (p < 0.09) posed a lesser risk of developing glaucoma. Almost all were treated with topical steroids and oral acyclovir. The need for glaucoma surgery, in our study, was only 7.2%. Majority of patients with glaucoma, as compared to those without, appeared to have a higher number of IOP spikes and uveitic episodes. CMV-associated eyes had higher risk of developing glaucoma and were more intractable, requiring more intense treatment strategies. This review of the clinical profile of an exclusive South Indian cohort of VKU with an attempt to understand the differences in presentation between the herpetic and CMV groups and its implication from a glaucoma perspective makes this study distinctive.

How to cite this article: Sudhakar P, Menon M, CK M, et al. Glaucoma in Viral Keratouveitis: A Retrospective Review at a Tertiary Eye Hospital. J Curr Glaucoma Pract 2022;16(1):65-70.

Keywords: Ahmed glaucoma valve; Antiglaucoma medication; Cytomegalovirus; Herpes simplex virus; Intraocular pressure; Ocular hypertension; Transscleral cyclophotocoagulation; Uveitic glaucoma; Varicella Zoster; Viral keratouveitis.

Figs 1A to C

Clinical signs of VKU

Fig. 2

Age distribution of VKU patients in our study

Fig. 3

Proportion of eyes with HSV, HZO and CMV keratouveitis

Fig. 4

Various associated ocular features/sequelae of VKU

Fig. 5

Association between the number of IOP spikes and development of glaucoma

Fig. 6

Medical therapy in patients with VKU