title: Pediatric herpes simplex virus keratitis.
abstract: OBJECTIVE
  To report the clinical characteristics and visual outcomes of pediatric herpes simplex virus (HSV) keratitis.
  
  
  METHODS
  The medical records of 29 patients younger than 16 years with HSV keratitis who were diagnosed and treated at Chang Gung Memorial Hospital, Taoyuan, Taiwan, between 1996 and 2004 were retrospectively reviewed. The diagnosis of HSV keratitis was proven by a positive viral culture and/or real-time quantitative polymerase chain reaction or by a clear history of dendritic keratitis or herpetic kerato-uveitis. Type of HSV keratitis, recurrence rate, and visual outcome were analyzed.
  
  
  RESULTS
  The average age at the entry into the study was 5.7 years (range: 7 months to 15 years). Mean follow-up time was 35.3 months (range: 2-69 months). Epithelial keratitis including dendritic and geographic ulcers was noted in 14 eyes, stromal keratitis in 2 eyes, stromal keratitis concurrent with epithelial keratitis in 8 eyes, and endotheliitis in 6 eyes. One patient had sequential involvement of both eyes. Thirteen patients (45%) developed recurrent HSV keratitis after the first documented episode. Female gender (but not age or the type of keratitis) was significantly associated with recurrences. Five patients who were maintained on oral valacyclovir prophylaxis up to 1 year had no recurrence during the period. Fifteen of 21 patients younger than 8 years of age had best-corrected visual acuity available at last follow-up, and 10 patients developed amblyopia.
  
  
  CONCLUSIONS
  Children with HSV keratitis are at risk for recurrent keratitis and amblyopia. Prolonged systemic antiviral prophylaxis may help to prevent such consequences.
authors.affiliation: From the Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan, Republic of China.
authors.forename: Ching-Hsi
authors.initials: CH
authors.lastname: Hsiao
authors.forename: Ling
authors.initials: L
authors.lastname: Yeung
authors.forename: Lung-Kun
authors.initials: LK
authors.lastname: Yeh
authors.forename: Ling-Yu
authors.initials: LY
authors.lastname: Kao
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Tan
authors.forename: Nan-Kai
authors.initials: NK
authors.lastname: Wang
authors.forename: Ken-Kuo
authors.initials: KK
authors.lastname: Lin
authors.forename: David H K
authors.initials: DH
authors.lastname: Ma
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D016849:Keratitis, Herpetic / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014776:Virus Cultivation; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir