Treatment Duration Linked to Early Recurrence of Herpetic Stromal Keratitis

Early recurrence of herpetic stromal keratitis was significantly associated with shorter systemic antiviral and topical steroid treatment durations, emphasizing the importance of timely and sustained therapy. Photo: Lisa Marten, MD. Click image to enlarge. Repeated flare-ups of herpetic stromal keratitis, caused by the herpes virus, can damage the cornea. Early recurrence can happen within six weeks after initial improvement, which led a group of researchers from Italy to investigate what could be causing these flares. Their results were presented this past Sunday at ARVO, identifying treatment timing and duration as primary factors.The retrospective, case-control study sought to investigate the demographic, clinical and treatment parameters as potential predictors of early recurrence of herpetic stromal keratitis (HSK). Eligibility criteria included clinical or PCR-confirmed HSK and at least six months of follow up. Patients were stratified into two groups: cases with early recurrences (≤6 weeks) and controls with no recurrence or late recurrences (>6 weeks).Among 111 HSK episodes from 51 adult and pediatric patients, 13 adults (12%) were associated with early recurrences and 4 children (12%). Researchers showed a statistically significant association between early recurrence and shorter duration of systemic antiviral (88.3 ±169.5 vs. 309.4 ±437.1 days) and topical steroid treatment (33.4 ±23.6 vs. 199.6 ±359.2 days). Adults differed from children in that no early recurrences were found after episodes treated with systemic antiviral for more than 91 days and with topical steroids for more than 77 days. An increased recurrence risk was correlated with delayed treatment initiation (10.4 ±10.2 days vs. 4.4 ±5.8 days). No demographic, seasonal or clinical factor showed to be statistically relevant for the outcome.The paper authors concluded that treatment regimen appears to be the primary predictive factor for early HSK recurrences. Although further multicentric studies should be conducted, preliminary data suggest an association between the choice of topical steroids and recurrence rates. “Our results highlight the impact of treatment timing and duration on HSK recurrence, especially in adults,” wrote the authors in their ARVO abstract. “While the data suggest that extended antiviral and steroid therapies may reduce early recurrences, these observations require confirmation through larger studies.”Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Villani E, Marelli L, Ferioli E, Luccarelli S, Bonsignore F, Maffezzoni E, Paolo N. Herpetic stromal keratitis recurrence: A retrospective case-control study. ARVO 2025 annual meeting.