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ABSTRACT
Viral keratitis is a significant cause of ocular morbidity and visual impairment worldwide. In recent years, there has been a growing understanding of the pathogenesis, clinical manifestations, and diagnostic modalities for viral keratitis. The most common viral pathogens associated with this condition are adenovirus, herpes simplex (HSV), and varicella-zoster virus (VZV). However, emerging viruses such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Vaccinia virus can also cause keratitis. Non-surgical interventions are the mainstay of treatment for viral keratitis. Antiviral agents such as Acyclovir, Ganciclovir, and trifluridine have effectively reduced viral replication and improved clinical outcomes. Additionally, adjunctive measures such as lubrication, corticosteroids, and immunomodulatory agents have alleviated symptoms by reducing inflammation and facilitating tissue repair. Despite these conservative approaches, some cases of viral keratitis may progress to severe forms, leading to corneal scarring, thinning, or perforation. In such instances, surgical intervention becomes necessary to restore corneal integrity and visual function. This review article aims to provide an overview of the current perspectives and surgical interventions in managing viral keratitis. The choice of surgical technique depends on the extent and severity of corneal involvement. As highlighted in this article, on-going research and advancements in surgical interventions hold promise for further improving outcomes in patients with viral keratitis.
ABBREVIATIONS
| HSV | = | Herpes Simplex virus |
| CMV | = | Cytomegalo virus |
| VZV | = | Varicella zoster virus |
| EBV | = | Epstein Barr virus |
| HSK | = | Herpes Simplex keratitis |
| VZK | = | Varicella Zoster keratitis |
| HZO | = | Herpes Zoster ophthalmicus |
| HHV | = | Human Herpes virus |
| HTLV | = | Human T lymphocyte virus |
| TLR | = | Toll-like receptors |
| RNA | = | Ribonucleic acid |
| DNA | = | Deoxyribonucleic acid |
| IOP | = | Intraocular pressure |
| RB | = | Rose Bengal |
| T cells | = | Thymus producing lymphocytes |
| IFN | = | Interferon |
| TNF | = | Tumour necrosis factor |
| RANTES | = | Regulated upon activation, normal T cell expressed and presumably secreted |
| ADCC | = | Antibody-dependent cellular cytotoxicity |
| IL-12 | = | Interleukin 12 |
| IE62 | = | Major transcriptional regulatory protein encoded by VZV |
| ORF | = | Open reading frame |
| NK | = | Natural killer |
| NKG | = | NK cell activator receptor |
| KP | = | Keratic precipitates |
| DMF | = | Descemet membrane folds |
| SPK | = | Superficial punctate keratitis |
| PCR | = | Polymerase chain reaction |
| RT-PCR | = | Reverse transcriptase PCR |
| ELISA | = | Enzyme-linked immunosorbent assay |
| ASOCT | = | Anterior segment optical coherence tomography |
| HRT2-RCN | = | Heidelberg Retina Tomograph 2 Rostock Cornea Module |
| IVCM | = | In vivo confocal microscopy |
| CS | = | Corneal scrapings |
| IFA | = | Reverse transcriptase PCR |
| qPCR | = | Quantitative real time PCR |
| sIgA | = | Secretory immunoglobulin A |
| IgG | = | Immunoglobulin G |
| IgM | = | Immunoglobulin M |
| MDH | = | Multiplex dot hybridization |
| ICGA | = | Immunographic assay |
| ICPO | = | Infected cell protein 0 |
| ELVIS | = | Enzyme-linked virus inducible system |
| HEDS | = | Herpes Eye Disease Study |
| ACV | = | Acyclovir |
| HIV | = | Human immunodeficiency virus |
| TK | = | Thymidine kinase |
| FDA | = | Food and Drug Administration |
| gD | = | Glycoprotein D |
| CRISPR | = | Clustered regularly interspaced short palindromic repeats |
| BX795 | = | Potent ATP-competitive inhibitor of 3- phosphoinositide dependent protein kinase 1 (PDK 1 |
| PED | = | Persistent epithelial defects |
| SFCAP | = | Superior forniceal conjunctival advancement pedicle |
| AMG | = | Amniotic membrane grafts |
| DALK | = | Deep anterior lamellar keratoplasty |
| DSEK | = | Descemet’s membrane endothelial keratoplasty |
| CN | = | Corneal neurotization |
| DCN | = | Direct corneal neurotization |
| IDCN | = | In direct corneal neurotization |
| VEGF | = | Vascular endothelial growth factor |
| CNV | = | Corneal neovascularization |
| DHA | = | Docosahexaenoic acid |
| BVC | = | Bevacizumab |
Disclosure statement
No potential conflict of interest was reported by the author(s).
Author contributions
Josephine Christy: Writing – original draft and review Vaidheki referencing and original draft Veeramma, Preethi P, Veena P, Mangala P: Writing – original draft. Aditee M Writing – review, , photos courtesy & editing. Ramakrishnan Rangappa, Meenakshi Ravindran: Supervision. Venugopal Anitha: Conceptualization; Literature Search, Referencing, Writing – review & editing, Original draft.