HERPES-ZOSTER PERIPHERAL ULCERATIVE KERATITIS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herp es varicella-zoster virus in patients with the acquired immunodeficien cy syndrome (AIDS). Three AIDS patients with ocular herpes tester infe ction (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral ke ratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy, Two of the patients respond ed well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis d eveloped. The third patient had a recurrent. episode of inflammation w ith PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella-zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct dia gnosis and aggressive early long-term systemic antiviral treatment mus t be instituted to control inflammation, ulcer progression, and compli cations.