acyclovir and Corneal-Neovascularization

Corneal transplantation is a common surgical intervention for restoring vision loss due to corneal damages. However, for cultural reasons, there is a huge shortage of donor corneas in China. Acellular porcine corneal stromas (APCSs) can be used as corneal substitutes in lamellar keratoplasty for corneal ulcers. This study was conducted to analyze the results of APCS use for herpes simplex keratitis (HSK).. The study involved HSK patients who underwent keratoplasty with APCSs from February 2016 to October 2017 in the second affiliated hospital of Zhejiang University. Patient data were collected at 7 days, 1 month, 3 months, 6 months, and at the last follow-up (7-25 months) postoperative. The corneal transparency, neovascularization, visual acuity, and graft stability were observed.. Thirteen patients with HSK including five patients with corneal perforation were included in this study, nine patients underwent deep anterior lamellar keratoplasty (DALK) and five perforation patients underwent double lamellar keratoplasty. There were nine men and four women with an average age of 62.5 ± 5.6 years old (ranging from 52 to 70 years old). The mean postoperative follow-up duration was 15.1 ± 5.8 months (ranging from 7 to 25 months). At the last visit, visual acuity improved in nine patients (69.2%) compared with preoperative (P = 0.008).The grafts of seven individuals (53.8%) were completely transparent or slightly opaque; their corneal transparency score had improved significantly compared with before the surgery (P = 0.010). Various degrees of neovascularization were present in 11 of the 13 patients (84.6%), most neovascularization gradually stabilized. Graft dissolution occurred in three eyes (23.1%) during the observation period, two underwent regrafting, the other one became stable after treatment. Three patients underwent second allograft transplantation, two of which encountered APCS graft dissolution and one of the patients requested a human donor allograft transplantation due to transparency issues despite the absence of adverse issues.. Acellular porcine corneal stroma seems to be effective in the treatment of HSK and can be used in HSK with corneal perforation by using double lamellar keratoplasty in an emergency.

Topics: Acyclovir; Aged; Animals; Antiviral Agents; Corneal Neovascularization; Corneal Opacity; Corneal Perforation; Corneal Stroma; Corneal Transplantation; Female; Humans; Keratitis, Herpetic; Male; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Swine; Transplantation, Heterologous; Treatment Outcome

To report a case of recurrent herpes simplex keratitis after verteporfin photodynamic therapy for corneal neovascularization.. A 69-year-old man who had lipid keratopathy with corneal neovascularization secondary to herpes simplex keratitis in the right eye and who was treated with topical steroid received photodynamic therapy with verteporfin. Six neovascular areas in the cornea were treated consecutively to occlude new vessels and reduce the risk of allograft rejection after subsequent keratoplasty.. Three days after verteporfin photodynamic therapy, there was evidence of vascular occlusion. However, a herpetic epithelial ulcer was detected in the cornea. Ten days after treatment, the lesion progressed to a geographic ulcer. After topical and systemic acyclovir treatment, the lesion healed. Five months after treatment, penetrating keratoplasty and postoperative antiviral prophylaxis were performed. During a follow-up period of 12 months, the graft remained clear with visual acuity of 20/40.. Herpes simplex keratitis can recur after verteporfin photodynamic therapy for corneal neovascularization.

Topics: Acyclovir; Aged; Antiviral Agents; Corneal Neovascularization; Humans; Keratitis, Herpetic; Male; Photochemotherapy; Photosensitizing Agents; Porphyrins; Recurrence; Verteporfin; Virus Activation; Visual Acuity

To identify whether histopathologic presence of neovascularization is predictive for allograft failure following penetrating keratoplasty for herpes simplex virus (HSV) keratitis.. Retrospective, interventional case series of 62 consecutive patients with HSV keratitis who underwent penetrating keratoplasty at the Kellogg Eye Center between 1990 and 2000. Reviews of the patients' clinical charts and the histopathologic slides of their excised corneal buttons were performed to identify associations between histopathologic neovascularization and clinical outcomes.. To determine whether histopathologic presence of neovascularization predicts allograft failure.. Histopathologic presence of neovascularization was present in 31% of corneal specimens and predicted subsequent allograft failure (P = 0.002) and HSV recurrence (P = 0.05).. Histopathologic presence of neovascularization is a risk factor for corneal allograft failure and HSV recurrence.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Child, Preschool; Corneal Neovascularization; Drug Therapy, Combination; Female; Glucocorticoids; Graft Rejection; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Prednisolone; Recurrence; Retrospective Studies; Risk Factors; Transplantation, Homologous

To report an 81-year-old woman with corneal neovascularization secondary to herpetic stromal keratitis treated with subconjunctival bevacizumab and to discuss the role of this novel antiangiogenic treatment.. Case report and review of medical literature.. A dramatic regression of corneal vessels was observed 1 week after the injection. After a 3-month follow-up, there was no recurrence of corneal revascularization.. Bevacizumab may be a valid complementary treatment in patients with corneal neovascularization caused by herpetic stromal keratitis.

Topics: Acyclovir; Aged, 80 and over; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bevacizumab; Corneal Neovascularization; Corneal Stroma; Female; Humans; Keratitis, Herpetic; Treatment Outcome; Vascular Endothelial Growth Factor A

The purpose of the study is to investigate whether analysis of specific antibody synthesis can aid the diagnosis of herpes keratitis.. Aqueous humor was collected from 39 patients with presumed recurrent herpes keratitis, including 23 consulting for keratitis and 16 patients scheduled for penetrating keratoplasty. Local antibody production was ascertained by analysis of paired aqueous humor/serum samples, using a modified micro-ELISA technique.. Local production of antibodies was found in 32 patients (82%): anti-herpes simplex virus (HSV) antibodies in 26 (67%) and anti-varicella zoster virus (VZV) antibodies in 11 (28%). Twenty of 23 patients with active keratitis (87%), and 12 of 16 undergoing keratoplasty (75%), tested positive. Five patients had local production of both anti-HSV and anti-VZV antibodies, whereas seven patients tested negative. Local antibody production was significantly associated with intraocular inflammation (P<0.05), corneal neovascularisation (P<0.05), and positive response to anti-viral treatment (P<0.05). No complications were encountered in sampling aqueous humor.. Assessment of local anti-HSV and -VZV antibody production is a safe and reliable diagnostic procedure for recurrent herpes keratitis. It might be particularly helpful in patients presenting with intraocular inflammation and neovascularisation since it discriminates between herpes and non-herpes pathologies and may therefore be useful for preventive and therapeutic strategies.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Corneal Neovascularization; Enzyme-Linked Immunosorbent Assay; Female; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Recurrence; Risk Factors; Uveitis

To review the clinical characteristics and visual outcomes of patients with bilateral herpetic keratitis.. Retrospective, noncomparative, observational case series.. A retrospective review of medical records of 544 patients with herpes simplex virus (HSV) eye disease treated between January 1996 and September 2001 was performed at the Department of Ophthalmology, University of Minnesota. Seven patients (1.3%) with bilateral herpetic keratoconjunctivitis were identified.. In these seven patients, the age at the initial onset of corneal disease ranged from 7 weeks to 46 years, with a median of 18 years and a mean of 19.3 years. Five patients had systemic atopy, and two patients had severe ocular rosacea. Systemic immune disorders were noted in two patients. Recurrent blepharoconjunctivitis was noted in 8 eyes (57%), epithelial keratitis in 12 eyes (85.7%), stromal keratitis in 9 eyes (64.3%), necrotizing stromal keratitis in 5 eyes (35.7%), and progressive endotheliitis in 2 eyes (14.2%). Corneal complications included opacification, neovascularization, and corneal thinning or perforation. Penetrating keratoplasty was performed in 1 eye, in which endophthalmitis subsequently developed and which required enucleation. Four patients with continued use of oral antiviral prophylaxis (acyclovir 400 mg twice daily) since September 1999 showed significant decreases in recurrence. The average remission in these four patients was 1.7 years. The visual acuity at the last follow-up was 20/40 or worse in 6 eyes (42.8%).. In contrast to unilateral HSV keratitis, our patients with bilateral herpetic corneal infections had underlying atopy or immune deviations and evinced more protracted clinical courses. Long-term prophylactic antiviral treatment has reduced the incidence of recurrence in this group of patients.

Topics: Acyclovir; Adolescent; Adult; Age of Onset; Antiviral Agents; Child, Preschool; Corneal Neovascularization; Corneal Opacity; Corneal Stroma; Epithelium, Corneal; Female; Humans; Infant; Keratitis, Herpetic; Keratoconjunctivitis; Keratoplasty, Penetrating; Male; Middle Aged; Recurrence; Retrospective Studies; Visual Acuity

We have previously shown that basic fibroblast growth factor (FGF-2) enhances corneal epithelial healing in different experimental models in vivo. In order to study the healing effect of this growth factor in pathological conditions of the cornea, we investigated whether topical application of FGF-2 could affect herpes keratitis in rabbits. Since HSV-1 infection is prevented in vitro by incubation with heparin, we also topically applied heparin and suramin, considering the similar interaction of herpes simplex virus and FGF-2 with cell membrane-anchored heparan sulfate.. After virus inoculation with a human BEY.2 strain, rabbits were treated with either FGF-2 (200 ng to 2 micrograms/application), heparin (250 micrograms/application) or suramin (250 micrograms/application) 4 times daily until day 14. Acyclovir and placebo administrations served as controls (n = 48 rabbits). Computerized ulcer surface analysis, clinical observations and virus recovery assays were performed.. Topical FGF-2, heparin and suramin treatment revealed a significant reduction in peak ulcer sizes, and complete epithelial healing was achieved earlier than in placebo-treated corneas. However, no significant antiviral effect of FGF-2, heparin and suramin was detectable in plaque assays from conjunctival swabs.. These experiments demonstrate that FGF-2 is effective in promoting herpetic epithelial ulcer healing, either due to its proliferative effects on epithelial cells or indirectly by occupying the sites on cell surface heparan sulfate necessary for the attachment of the virion. The latter mechanism of action is presumably the reason for the similar effect of heparin and suramin.

Topics: Acyclovir; Administration, Topical; Animals; Corneal Neovascularization; Corneal Opacity; Drug Therapy, Combination; Epithelium, Corneal; Eye Infections, Viral; Female; Fibroblast Growth Factor 2; Follow-Up Studies; Heparin; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Ophthalmic Solutions; Rabbits; Suramin; Tears; Wound Healing