單純性皰疹性樹突狀角膜炎

2023 年 9 月 23 日， NEJM.org

一名 38 歲男子因左眼流淚、畏光和視力下降 2 週病史就診於眼科診所。就診前兩年，他在左眼接受了深前板層角膜移植手術（也稱為部分角膜移植術）以治療晚期圓錐角膜。眼科檢查顯示，左眼最佳矯正視力為20/80。隨後的裂隙燈檢查顯示輕度結膜充血和分支上皮潰瘍，末端球部涉及角膜移植物。在鈷藍濾光片照明下觀察角膜的螢光素染色（見圖），可以進一步觀察樹突狀潰瘍。診斷為單純皰疹性樹突狀角膜炎。角膜炎是眼部單純皰疹感染最常見的形式。通常根據病史和檢查結果做出診斷。單純性皰疹性角膜炎會使角膜移植變得複雜；因此，接受角膜移植的患者應受到充分的監護。開始使用每天五次的局部 3% 阿昔洛韋軟膏 (acyclovir ointment) 進行治療。 10天追蹤時，患者症狀減輕，角膜移植完全癒合，最佳矯正視力恢復至基線20/25。

DOI：10.1056/NEJMicm2302973

Stephanie V. Sherman，醫學博士，單純皰疹性樹突狀角膜炎編輯《新英格蘭醫學雜誌》

Herpes Simplex Dendritic Keratitis

September 23, 2023, at NEJM.org

A 38-year-old man presented to the ophthalmology clinic with a 2-week history of tearing, photophobia, and reduced visual acuity in his left eye. Two years before presentation, he had undergone a deep anterior lamellar keratoplasty — also known as a partial-thickness corneal transplantation — on the left eye to treat advanced keratoconus. On ophthalmologic examination, the best corrected visual acuity of the left eye was limited to 20/80. A subsequent slitlamp examination revealed mild conjunctival hyperemia and a branching epithelial ulcer with terminal bulbs involving the corneal graft. Fluorescein staining of the cornea that was viewed under illumination through a cobalt blue filter (see image) allowed further visualization of the dendritic ulcer. A diagnosis of herpes simplex dendritic keratitis was made. Keratitis is the most common form of ocular herpes simplex infection. The diagnosis is typically made on the basis of history and examination findings. Herpes simplex keratitis can complicate corneal transplants; therefore, patients who undergo corneal transplantation should be carefully monitored. Treatment with a course of topical 3% acyclovir ointment applied five times per day was initiated. At a 10-day follow-up visit, the patient’s symptoms had abated, the corneal graft had completely healed, and his best corrected visual acuity was restored to the baseline level of 20/25.

DOI: 10.1056/NEJMicm2302973

Stephanie V. Sherman, M.D., Editor Herpes Simplex Dendritic Keratitis The New England Journal of Medicine