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Tear HSV-Specific Secretory IgA as a Potential Indicator for Recurrent Stromal Herpes Simplex Keratitis: A Preliminary Study

Huang, Fei-fei MM; Wang, Zhu-jian MM; Zhang, Chao-ran MD

doi: 10.1097/ICO.0b013e31828a8b96
Clinical Science

Purpose: To assess the herpes simplex virus–specific tear secretory IgA (sIgA) and its correlation with specific serum antibodies and to evaluate the possible value of specific tear sIgA for prediction of herpes simplex keratitis (HSK) recurrence.

Methods: Tear sIgA and paired serum IgG/IgM/IgA from 41 stromal HSK patients and 15 controls were analyzed by enzyme-linked immunosorbent assay. Subsequent follow-up for monitoring recurrence was performed from the time of first cure on all patients for 4 months to 1 year.

Results: Serum IgG was positive in all participants. The concentration of serum IgA increased with the levels of tear sIgA (P = 0.017). The tear sIgA–positive rate was 36.59% in stromal keratitis, whereas none of the controls were found as sIgA positive. Positivity of sIgA was the only potential factor for predicting the risk of herpes keratitis recurrence (hazard ratio = 9.04; 95% confidence interval, 1.06–77.44; P = 0.045), with a sensitivity of 83.3% and a specificity of 71.4% (P = 0.034; 95% confidence interval, 0.58–0.97). Tear sIgA–positive patients had significantly shorter relapse-free survival compared with tear sIgA–negative patients (P = 0.015).

Conclusions: This is the first preliminary study suggesting that the levels of tear sIgA could be a potential prognostic parameter for the recurrence of HSK.

Supplemental Digital Content is Available in the Text.

Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.

Reprints: Chao-ran Zhang, No. 83, Fenyang Rd, Xuhui District, Shanghai 200031, China (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received September 20, 2012

Accepted January 29, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.