A COMPARISON OF ENZYME-IMMUNOASSAY AND POLYMERASE CHAIN-REACTION WITHTHE CLINICAL EXAMINATION FOR DIAGNOSING OCULAR HERPETIC DISEASE

Purpose: The results of two laboratory diagnostic herpes simplex virus (HSV) tests, an enzyme immunoassay (improved Herpchek [iHC]) and the polymerase chain reaction (PCR), were compared with the clinical exami nation in the diagnosis of HSV. We determined when diagnostic laborato ry tests provided the initial diagnosis of HSV ocular disease and when they were only confirmatory. Methods: The sensitivity and specificity of iHC and PCR were determined using 22 HSV culture-positive clinical samples, 1 0 adenovirus culture-positive clinical samples, 5 samples from normal conjunctivas, 4 bacterial samples, and 1 sample containing Varicella zoster virus. The medical history of the 22 patients with p ositive HSV cultures were reviewed to determine the initial diagnosis by clinical examination and the initial therapy. Results: For typical presentations of ocular HSV disease, the clinical examination is as ac curate as iHC (P = 0.99) and PCR (P = 0.24). However, for atypical pre sentations of ocular HSV disease, iHC (P = 0.000005) or PCR (P = 0.000 06) were more accurate in detecting HSV infection than the clinical ex amination. Conclusion: Laboratory diagnosis of HSV from ocular samples was most useful to the clinician in atypical presentations of herpeti c ocular disease.