Abstract：
BACKGROUND: Herpes zoster ophthalmicus includes a wide spectrum of lesions at the ocular surface, including epithelial, stromal, endothelial keratitis, and uveitis. Thus far, the occurrence of corneal endothelial disorder in herpes zoster ophthalmicus and the causative virus have not been confirmed, and the differential diagnosis and establishment of therapeutic strategies are challenging. Corneal endothelial coin-shaped lesions are well known to occur in cytomegalovirus-related corneal endotheliitis but have not been reported in patients with herpes zoster ophthalmicus.
METHODS: A 39-year-old Asian female was referred to our ophthalmology department with recurrent anterior uveitis accompanied by coin-shaped corneal endothelial scar-like lesions that appeared after right facial herpes zoster. Diffuse corneal stromal haziness was mostly limited in the anterior stroma. The coin-shaped corneal endothelial lesions were separate from stromal lesions and showed a high-reflective scar-like line in sections of anterior segment optical coherence tomography. Anterior uveitis recurred each time she discontinued oral antiviral drug treatment for 12 months after the first event, but was remitted by the maintenance medications of combined topical ganciclovir gel with oral valaciclovir, at a dose lower than the usual adult dose, for acute or recurrent zoster-associated anterior uveitis. Corneal endothelial function remained normal and corneal endothelial and stromal lesions were unchanged throughout the treatment and follow-up period.
CONCLUSIONS: In patients with a history of facial herpes zoster with coin-shaped corneal endothelial scar accompanying recurrent anterior uveitis, suspicion for active varicella-zoster virus is warranted, and prolonged intake of oral antiviral agents is required despite varicella-zoster virus DNA not being detected in aqueous humor.
METHODS: A 39-year-old Asian female was referred to our ophthalmology department with recurrent anterior uveitis accompanied by coin-shaped corneal endothelial scar-like lesions that appeared after right facial herpes zoster. Diffuse corneal stromal haziness was mostly limited in the anterior stroma. The coin-shaped corneal endothelial lesions were separate from stromal lesions and showed a high-reflective scar-like line in sections of anterior segment optical coherence tomography. Anterior uveitis recurred each time she discontinued oral antiviral drug treatment for 12 months after the first event, but was remitted by the maintenance medications of combined topical ganciclovir gel with oral valaciclovir, at a dose lower than the usual adult dose, for acute or recurrent zoster-associated anterior uveitis. Corneal endothelial function remained normal and corneal endothelial and stromal lesions were unchanged throughout the treatment and follow-up period.
CONCLUSIONS: In patients with a history of facial herpes zoster with coin-shaped corneal endothelial scar accompanying recurrent anterior uveitis, suspicion for active varicella-zoster virus is warranted, and prolonged intake of oral antiviral agents is required despite varicella-zoster virus DNA not being detected in aqueous humor.
摘要：
背景：眼带状疱疹在眼表包括广泛的病变，包括上皮,基质,内皮性角膜炎,还有葡萄膜炎.到目前为止,眼带状疱疹和致病病毒的角膜内皮疾病的发生尚未得到证实，鉴别诊断和治疗策略的建立具有挑战性。众所周知，角膜内皮硬币形病变发生在巨细胞病毒相关的角膜内皮炎中，但在带状疱疹眼患者中尚未报道。
方法：一名39岁的亚裔女性因复发性前葡萄膜炎并伴有右侧面部带状疱疹后出现的硬币状角膜内皮瘢痕样病变而转诊至我们的眼科。弥漫性角膜基质混浊主要限于前基质。硬币形角膜内皮病变与基质病变分开，并在眼前段光学相干断层扫描的切片中显示出高反射性瘢痕状线。前葡萄膜炎复发每次她停止口服抗病毒药物治疗12个月后，但通过局部更昔洛韦凝胶与口服伐昔洛韦联合的维持药物缓解，剂量低于通常的成人剂量，急性或复发性带状疱疹相关性前葡萄膜炎。在整个治疗和随访期间，角膜内皮功能保持正常，角膜内皮和基质病变无变化。
结论：在有面部带状疱疹病史并伴有复发性前葡萄膜炎的硬币状角膜内皮瘢痕的患者中，怀疑是活跃的水痘-带状疱疹病毒，尽管在房水中未检测到水痘-带状疱疹病毒DNA，但仍需要长期摄入口服抗病毒剂。
方法：一名39岁的亚裔女性因复发性前葡萄膜炎并伴有右侧面部带状疱疹后出现的硬币状角膜内皮瘢痕样病变而转诊至我们的眼科。弥漫性角膜基质混浊主要限于前基质。硬币形角膜内皮病变与基质病变分开，并在眼前段光学相干断层扫描的切片中显示出高反射性瘢痕状线。前葡萄膜炎复发每次她停止口服抗病毒药物治疗12个月后，但通过局部更昔洛韦凝胶与口服伐昔洛韦联合的维持药物缓解，剂量低于通常的成人剂量，急性或复发性带状疱疹相关性前葡萄膜炎。在整个治疗和随访期间，角膜内皮功能保持正常，角膜内皮和基质病变无变化。
结论：在有面部带状疱疹病史并伴有复发性前葡萄膜炎的硬币状角膜内皮瘢痕的患者中，怀疑是活跃的水痘-带状疱疹病毒，尽管在房水中未检测到水痘-带状疱疹病毒DNA，但仍需要长期摄入口服抗病毒剂。
