ESCRS - FPM06.06 - Exploring The Potential Causes Of Herpes Simplex Virus Keratitis (Hsk) Recurrence In Children: Does Ultraviolet (Uv) Light Exposure Have A Role?

Exploring The Potential Causes Of Herpes Simplex Virus Keratitis (Hsk) Recurrence In Children: Does Ultraviolet (Uv) Light Exposure Have A Role?

Published 2022 - 40th Congress of the ESCRS

Reference: FPM06.06 | Type: Free paper | DOI: 10.82333/mcb3-de81

Authors: Stefano Lucentini* 1 , Saverio Vincenzo Luccarelli 2 , Cecilia Acuti Martellucci 3 , Luca Marelli 4 , Paolo Nucci 5

1Ospedale Maggiore di Lodi,Lodi,Italy, 2Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico,Milan,Italy, 3Department of Environmental and Prevention Sciences,University of Ferrara,Ferrara,Italy, 4Eye Clinic San Giuseppe Hospital, IRCCS Multimedica,Milan,Italy, 5Department of Clinical Sciences and Community Health,University of Milan,Milan,Italy

Purpose

To investigate the possible association of ultraviolet light (UV) exposure to Herpes Simplex Keratitis (HSK) onset in a cohort of pediatric patients.

Setting

Single center (Eye Clinic-San Giuseppe University Hospital, Milan), retrospective cohort study.

Methods

Initial and recurring HSK episodes were collected for children <13 years, from December 2011 to July 2021. Patients had monthly follow up visits. To explore the potential association of HSK recurrences with exposure to UV, the months from March to October, when the UV index in Milan ranges from 4 to 8, were classified as “high UV exposure”, while months with UV index <4, were classified as “low UV exposure”. To account for the time elapsed between each recurrence, and for the multiple episodes of each subject, a conditional risk set model (Prentice, Williams, and Peterson) was used, adjusting for sex, underlying chronic diseases, and the use of antiviral prophylaxis. Analyses were carried out using STATA 15.1 (College Station, TX).

Results

17 children, aged on average 6.2 years at presentation (ranging from 1 to 12 years), had a total of 39 HSK episodes over a mean follow up of 3.8 years. There were 1.3 initial episodes and 1.5 recurrences per month during “low UV exposure”, and 2.0 initial episodes and 2.7 recurrences per month during “high UV exposure” (Figure 1). However, this difference was not statistically significant (p=0.2). Importantly, while exposure to UV light showed no association with recurrences in multivariate analyses as well, it appeared relevant to explaining the role of antiviral prophylaxis: children complying with it had an adjusted hazard ratio of recurrence of 0.30 (95% Confidence Intervals 0.09-0.96) compared to those who did not undergo prophylaxis.

Conclusions

The role of UV exposure in inducing HSK recurrences has been partially investigated in previous studies on adults.1-3 We performed the first evaluation of this potential association in children. The results showed more HSK episodes during months with high UV exposure, though the difference was not significant. Interestingly, the findings suggest the crucial role of antiviral prophylaxis in reducing the risk of HSK recurrence, also when the exposure to UV is higher, and thus compliance to prophylaxis should be encouraged.4 Given the relatively small sample, a possible association between UV exposure and HSK recurrence cannot be excluded. As a precautionary measure, wearing UV-blocking sunglasses should be recommended in children who had HSK.