acyclovir and Corneal-Edema

We treated six eyes of five patients with linear endotheliitis. This entity appears clinically as a line of keratic precipitates on the corneal endothelium that progresses centrally and is accompanied by peripheral stromal and epithelial edema. All five patients had ocular pain, redness, and photophobia. One eye had an episode of a dendritic lesion typical of herpes simplex. Two eyes had a history of cataract extraction before developing linear endotheliitis. We treated all patients aggressively with a combination of corticosteroids and antiviral agents. Complete resolution of inflammation and edema occurred in all cases. Four patients required the use of oral acyclovir to control the inflammation and prevent recurrence of the disease. Linear endothelitis is a distinct form of endotheliitis that may be associated with herpes simplex virus, and treatment included corticosteroid and antiviral therapy.

Topics: Acyclovir; Adult; Cataract Extraction; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Female; Glucocorticoids; Humans; Keratitis; Keratitis, Dendritic; Male; Middle Aged; Visual Acuity

To determine the efficacy of systemic acyclovir in decreasing complications and improving the outcome of penetrating keratoplasty for herpes simplex virus (HSV) keratitis.. Retrospective study of 53 primary penetrating keratoplasties for HSV keratitis at an eye hospital from January 1, 1989, through December 31, 1996. Medical records were analyzed for history of HSV keratitis, preoperative neovascularization, and disease activity. Postoperative use of acyclovir, recurrence of HSV keratitis, rejection, uveitis or edema, and graft failure were evaluated.. Twenty-four patients (mean +/- SD follow-up, 44.7 +/- 32.6 months) received no acyclovir and were compared with 20 patients, (mean +/- SD follow-up, 28.8 +/- 16.7 months), who received 400 mg acyclovir twice a day for at least 1 year. No patient in the acyclovir group had a recurrence of dendritic keratitis in the first year compared with 5 (21%) of the patients who did not receive acyclovir (P = .03). No patient had graft failure in the acyclovir group compared with 4 (17%) in the group without acyclovir after 1 year of follow-up (P = .06).. Postoperative systemic acyclovir therapy after penetrating keratoplasty for HSV keratitis is associated with a reduced rate of recurrent HSV dendritic keratitis and possible graft failure at 1 year of follow-up.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Corneal Edema; Drug Evaluation; Female; Follow-Up Studies; Graft Rejection; Herpesvirus 1, Human; Humans; Keratitis, Dendritic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Uveitis, Anterior; Visual Acuity

To report bilateral Herpes Simplex virus (HSV) keratitis in a patient on latanoprost for primi]k=8ary open angle glaucoma (POAG).. Case report.. A 76-year-old healthy male on latanoprost monotherapy for POAG polresented with sudden bilateral decreased vision. Examination showed bilateral dense corneal edema with loose epithelium. Aqueous fluid was positive for HSV-1 DNA on polymerase chain reaction (PCR). Latanoprost was discontinued, topical prednisolone acetate 1% eye, acyclovir 400 mg 5 times a day and combination of dorzolamide hydrochloride 2% and timolol maleate 0.5% twice daily were prescribed. The vision rapidly improved to 20/25 along with complete resolution of corneal edema within four weeks, with no recurrences over the next one year.. Bilateral simultaneous HSV endotheliitis is a rare condition and positive PCR test can help rule in the diagnosis. HSV keratitis is a known adverse event with Latanoprost use and can present atypically.

Topics: Acyclovir; Aged; Corneal Edema; Glaucoma, Open-Angle; Humans; Keratitis, Herpetic; Latanoprost; Male

The use of in vivo confocal microscopy has been valuable in detecting and managing corneal pathology. This case study documents endotheliitis using in vivo confocal microscopy where apparent resolution of endothelial edema on clinical examination resulted in the discovery of subclinical findings with confocal scanning. The purpose of this case study was to discuss a rare corneal pathology and the clinical value of confocal scanning.. A 30-year-old Asian Indian woman presented with unilateral endotheliitis and trabeculitis of presumed varicella zoster virus etiology. She was treated successfully with oral antiviral and topical corticosteroid therapy. Subclinical endotheliitis was detected using in vivo confocal microscopy, prompting the continuation of prophylactic, low-dose, topical corticosteroid therapy and topical hyperosmotics.. Further research is warranted to better understand the role of confocal microscopy in endotheliitis therapeutic management, endothelial cell count and morphology, and keratic precipitate characterization. To date, prophylactic oral antivirals and/or topical corticosteroids may play a role in immune suppression of the herpes virus, although prospective, randomized, controlled clinical trials have not focused specifically on endotheliitis cases.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis; Microscopy, Confocal; Prednisolone; Prospective Studies

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Cell Count; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Humans; Male; Prednisolone; Uveitis, Anterior; Valacyclovir; Valine; Visual Acuity

A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug.. Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly.

Topics: Acyclovir; Amantadine; Antiparkinson Agents; Aqueous Humor; Cataract Extraction; Ceftazidime; Corneal Edema; Corneal Endothelial Cell Loss; Corneal Opacity; Diagnostic Errors; Female; Humans; Keratitis; Middle Aged; Parkinson Disease; Postoperative Complications; Prednisolone; Saline Solution, Hypertonic; Vancomycin

To describe an atypical case of cytomegalovirus (CMV) endotheliitis in a 74-year-old man who presented with chronic corneal edema without keratic precipitates (KPs) and intraocular pressure (IOP) elevation.. Case report.. A complete ophthalmologic examination was performed. Polymerase chain reaction was used to test for herpes simplex virus, varicella zoster virus, and CMV DNA in aqueous humor samples to rule out viral endotheliitis.. Severe bullous keratopathy was found in the temporal part of the cornea without KPs or elevated IOP. CMV DNA was detected. Corneal edema subsided with oral valganciclovior.. CMV endotheliitis may present as corneal edema that lacks typical features, such as KPs or elevated IOP.

Topics: Acyclovir; Aged; Antiviral Agents; Corneal Edema; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Endothelium, Corneal; Ganciclovir; Humans; Intraocular Pressure; Keratitis, Herpetic; Male; Prednisolone; Valacyclovir; Valganciclovir; Valine; Visual Acuity

To report an unusual case of herpetic bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma.. A retrospective analysis of the case record of a 60-year-old man who had earlier undergone bilateral cataract surgery, was done. He presented with a complaint of decrease in vision in the right eye of 20 days duration. On examination, cornea showed epithelial bullae all over the surface with stromal and epithelial edema. Intraocular pressure was 30 mm of Hg in RE. He was treated with anti-glaucoma medications. Two dendritic lesions were seen in the cornea during a subsequent visit four days later. Virological investigations confirmed a diagnosis of Herpes simplex keratitis. He was treated with topical acyclovir.. This case highlights the fact that herpes simplex keratitis can present initially as a more diffuse corneal stromal and epithelial edema with epithelial bullae mimicking bullous keratopathy. Herpetic bullous keratitis, although unusual, should be considered in the differential diagnosis under such circumstances.

Topics: Acyclovir; Antiviral Agents; Cornea; Corneal Diseases; Corneal Edema; Corneal Stroma; Diagnostic Errors; Giant Cells; Glaucoma; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Male; Middle Aged; Pseudophakia; Retrospective Studies

To report a case of herpes zoster sine herpete presenting with hyphema.. A 69-year-old man was referred for traumatic hyphema and corneal edema in his left eye after a sandblast exposure three weeks previously. Slit-lamp examination demonstrated hyphema, anterior chamber inflammation, mid-dilated pupil, impaired corneal sensation, and high intraocular pressure, without any facial skin lesions. Iris fluorescein angiography revealed tortuosity and extensive occlusion of iris vessels. The patient was treated with oral acyclovir and intensive topical steroids with a presumed diagnosis of severe herpes zoster uveitis.. Clinical findings improved dramatically within several days. Typical sectorial iris atrophy with pupillary sphincter dysfunction and complete loss of corneal sensation developed after the resolution of intraocular inflammation.. Herpes zoster should be considered in patients with uveitis and hyphema even in the absence of typical skin rash.

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Cornea; Corneal Edema; Diagnosis, Differential; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Hyphema; Iris; Male; Severity of Illness Index

To report an eye with corneal endotheliitis and increased intraocular pressure in which the trabeculum demonstrated immunoreactivity for herpes simplex virus.. Case report. A 62-year-old man presented with increased intraocular pressure, keratic precipitates, and corneal stromal edema in his left eye. The tissue excised during trabeculectomy was immunohistochemically examined for herpetic viruses.. Immunoreactivity for herpes simplex virus was identified in the trabeculum.. Herpes simplex virus may cause trabeculitis and increased intraocular pressure in patients with corneal endotheliitis.

Topics: Acyclovir; Antibodies, Viral; Antigens, Viral; Antiviral Agents; Corneal Edema; Endothelium, Corneal; Herpesvirus 1, Human; Humans; Immunoenzyme Techniques; Intraocular Pressure; Keratitis, Herpetic; Male; Middle Aged; Trabecular Meshwork; Trabeculectomy; Visual Acuity

Two patients with previous corneal transplants developed unusual rejection-like episodes of the grafted cornea. Both had a migrating line of keratic precipitates and stromal edema involving both the donor and recipient corneas. Intensive steroid treatment attained little effect, but oral acyclovir treatment dramatically suppressed the disease process. The facts suggest that a virus-related immune mechanism against both the donor and recipient endothelia, rather than simple allograft rejection, may have been responsible for the clinical presentations. Oral acyclovir therapy might be considered in patients with steroid-nonresponsive corneal endotheliitis mimicking allograft rejection.

Topics: Acyclovir; Administration, Oral; Adult; Corneal Edema; Corneal Stroma; Corneal Transplantation; Endothelium, Corneal; Female; Graft Rejection; Humans; Keratitis; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications