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Kirk R. Wilhelmus, MD, PhD; Bradley M. Mitchell, PhD; Chandler R. Dawson, MD; Dan B. Jones, MD; Bruce A. Barron, MD; Herbert E. Kaufman, MD; Joel Sugar, MD; Robert A. Hyndiuk, MD; Peter R. Laibson, MD; R. Doyle Stulting, MD, PhD; Penny A. Asbell, MD; for the Herpetic Eye Disease Study Group

Arch Ophthalmol. 2009;127(2):161-166.

Objective  To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis.

Methods  Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation.

Results  Stromal keratitis had a median area of 22.4 mm² (interquartile range, 12.8-31.6 mm²) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02).

Conclusions  Image analysis validly assesses the disciform geometry of herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.

Author Affiliations: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas (Drs Wilhelmus, Mitchell, and Jones); Francis I. Proctor Foundation, University of California, San Francisco (Dr Dawson); LSU Eye Center, Louisiana State University Health Sciences Center, New Orleans (Drs Barron and Kaufman); Illinois Eye and Ear Infirmary, University of Illinois at Chicago (Dr Sugar); Eye Institute, Medical College of Wisconsin, Milwaukee (Dr Hyndiuk); Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Laibson); Emory Eye Center, Emory University, Atlanta, Georgia (Dr Stulting); and Mount Sinai Medical Center, New York, New York (Dr Asbell). Drs Barron and Hyndiuk are now retired from academic practice.

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