acyclovir and Corneal-Ulcer

Acyclovir has been widely used against the various manifestations of eye disease due to herpes simplex since it first became generally available in the UK nearly five years ago. This paper discusses the rational indications for its use, through considerations of its pharmacology and pharmacokinetics, and through results of the many clinical trials that have been carried out to investigate its effects since its clinical efficacy was first demonstrated in 1979.

Topics: Acyclovir; Clinical Trials as Topic; Conjunctivitis, Viral; Corneal Ulcer; Herpes Simplex; Humans; Keratitis, Dendritic; Uveitis

The tolerability and efficacy of epidermal growth factor (EGF) in the topical treatment of herpetic corneal ulcers in addition to topical acyclovir have been evaluated in a double-blind, placebo-controlled, randomized study in two groups of patients. The time required for complete reepithelialization of the cornea was recorded, and the data obtained were analyzed statistically. In the EGF group, the reepithelialization was significantly faster than in the control group. Tolerability of EGF was always excellent. These results indicate that EGF is safe and effective in reducing the healing time of herpetic corneal ulcers.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Corneal Ulcer; Double-Blind Method; Epidermal Growth Factor; Female; Humans; Keratitis, Herpetic; Male; Middle Aged; Ophthalmic Solutions

Thus, we found that the role of Acyclovir in the treatment of viral corneal ulcer is definitely better and quicker. It takes less time for healing of corneal ulcer and as a result less hospitalisation is needed.

Topics: Acyclovir; Corneal Ulcer; Humans; Idoxuridine; Virus Diseases

Acyclovir has been widely used against the various manifestations of eye disease due to herpes simplex since it first became generally available in the UK nearly five years ago. This paper discusses the rational indications for its use, through considerations of its pharmacology and pharmacokinetics, and through results of the many clinical trials that have been carried out to investigate its effects since its clinical efficacy was first demonstrated in 1979.

Topics: Acyclovir; Clinical Trials as Topic; Conjunctivitis, Viral; Corneal Ulcer; Herpes Simplex; Humans; Keratitis, Dendritic; Uveitis

Fifty-one patients were treated in a dual-centre, double-blind comparison of acyclovir and adenine arabinoside in herpetic amoeboid (geographic) corneal ulceration. Twenty-four of the 25 patients receiving acyclovir healed in a mean time of 12.2 days, while 24 of the 26 patients treated with adenine arabinoside healed in a mean time of 11.0 days. There was no statistically significant difference between the two groups in terms of healing. A second analysis, excluding any patients who had received antiviral treatment immediately prior to entry into the study, showed that 18 of the 19 who received acyclovir healed in an average of 11.7 days and 18 of the 19 recipients of adenine arabinoside healed in a mean time of 11.2 days. Again the difference was not statistically significant.

Topics: Acyclovir; Clinical Trials as Topic; Corneal Ulcer; Double-Blind Method; Female; Humans; Keratitis, Dendritic; Male; Middle Aged; Time Factors; Vidarabine

A controlled trial of oral acyclovir in herpetic dendritic corneal ulcers was carried out on 31 patients. All patients received minimal wiping debridement of the ulcer, following which they were randomly allocated to receive either oral acyclovir or placebo for 7 days. At the end of treatment 67% of dendritic ulcers in patients receiving acyclovir had healed compared with 43% in placebo recipients. The proportion of ulcers healed in the 2 groups at 7 days showed no significant difference (p = 0.18), but the rate of healing was significantly faster in acyclovir group (p = 0.03).

Topics: Acyclovir; Administration, Oral; Clinical Trials as Topic; Corneal Ulcer; Female; Humans; Keratitis, Dendritic; Male; Middle Aged

The relative efficacy of aciclovir (ACV) and trifluorothymidine (TFT) was evaluated in a randomized, open clinical trial of 37 patients with herpetic kerato-uveitis. Twenty-one patients were treated with ACV and 16 with TFT. Topical steroids were withheld as long as the degree of inflammation permitted. Although both drugs were effective in healing the herpetic corneal ulcers, TFT had a significantly shorter healing time than ACV. However, ACV was more effective in treating the iridocyclitis than TFT. In 5 cases the keratouveitis responded to ACV alone, while only one case was successfully managed with TFT alone. Both drugs seemed to prevent steroid-induced epithelial complications and no significant side-effects were observed with either drug. The treatment of herpetic keratouveitis with single agents such as ACV and TFT is dependent upon rapidly instituting therapy and minimizing the use of topical steroids. The apparently good intraocular penetration of ACV and TFT may decrease the need for adjunctive steroid therapy and thereby minimize the risks of facilitated viral replication and steroid-dependence.

Topics: Acyclovir; Adrenal Cortex Hormones; Clinical Trials as Topic; Corneal Ulcer; Female; Humans; Keratitis, Dendritic; Male; Middle Aged; Random Allocation; Thymidine; Trifluridine; Uveitis; Uveitis, Anterior

A double-blind clinical trial of 3% acyclovir (Zovirax) and 3% adenosine arabinoside (ara-A, Vidarabine) in 93 patients with herpetic corneal ulceration is presented. Ulcers in 45 (94%) of acyclovir-treated patients and 37 (82%) ara-A-treated patients healed within 14 days. Patients treated with acyclovir healed more rapidly than those treated with ara-A (p less than 0.01). No serious adverse effects were observed.

Topics: Acyclovir; Clinical Trials as Topic; Corneal Ulcer; Double-Blind Method; Female; Guanine; Humans; Keratitis, Dendritic; Male; Middle Aged; Random Allocation; Vidarabine

Topics: Acyclovir; Clinical Trials as Topic; Corneal Transplantation; Corneal Ulcer; Humans; Keratitis, Dendritic; Middle Aged; Postoperative Complications; Vidarabine

We treated 25 patients with dendritic keratitis with debridement and 3% acyclovir ointment and another 25 with acyclovir alone. The patients were randomly assigned to the two treatment groups. There were only minimal adverse effects in both groups. The combination of debridement and acyclovir produced a significantly more rapid healing rate than did acyclovir alone. Factors associated with prolonged healing time were duration of symptoms (longer than one week), length of the epithelial defect (greater than 4 mm), proximity of the defect to the corneoscleral limbus (less than 2 mm), and the presence of stromal inflammation.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Clinical Trials as Topic; Corneal Ulcer; Debridement; Female; Follow-Up Studies; Guanine; Humans; Keratitis, Dendritic; Male; Middle Aged; Ointments; Random Allocation; Time Factors; Wound Healing

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Corneal Ulcer; Female; Guanine; Humans; Keratitis, Dendritic; Male; Middle Aged; Random Allocation; Recurrence; Vidarabine

In a masked controlled study, we treated 41 patients who had active herpes simplex corneal ulcers with either 3% acyclovir of 3% vidarabine ointment five times daily for 14 days. There was no statistically significant difference between the two drugs with reference to mean healing time, efficacy of healing, development of stromal keratitis or iritis, post-treatment visual acuity, or adverse reaction.

Topics: Acyclovir; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Corneal Ulcer; Female; Guanine; Humans; Keratitis, Dendritic; Male; Middle Aged; Vidarabine

Sixty patients were treated with either acyclovir 2% ointment or idoxuridine 1% ointment 5 times a day in a stratified randomised double-blind clinical trial. The 2 antiviral agents were equally effective.

Topics: Acyclovir; Clinical Trials as Topic; Corneal Ulcer; Double-Blind Method; Guanine; Humans; Idoxuridine; Keratitis, Dendritic; Male; Ointments; Random Allocation

The results of a randomised double-blind clinical trial of 3% acyclovir and 0.5% idoxuridine (IDU) ophthalmic ointments in 60 patients with corneal dendritic ulceration are presented. Ulcers in all 30 patients treated with acyclovir healed compared with 22 (76%) of 29 patients treated with IDU (P < 0.01). Patients treated with acyclovir healed more rapidly (average 4.4 days) than those who received IDU (average 9.2 days) (P < 0.01). No serious side effects were observed, though transient stinging was recorded in 8 patients receiving acyclovir and in 2 patients receiving IDU. Other side effects in the IDU treated group were watering in 2 patients and superficial punctate erosions in 6 patients.

Topics: Acyclovir; Adolescent; Adult; Aged; Child; Child, Preschool; Clinical Trials as Topic; Corneal Ulcer; Double-Blind Method; Female; Guanine; Humans; Idoxuridine; Keratitis, Dendritic; Male; Middle Aged; Ointments; Random Allocation; Time Factors

BACKGROUND Tyrosinemia Type II (TYRII) is a rare autosomal recessive inborn error of metabolism caused by deficiency of tyrosine aminotransferase (TAT), leading to hypertyrosinemia. TYRII patients often present in the first year of life with ocular and cutaneous findings, including corneal ulcers, pseudodendritic keratitis, and palmoplantar hyperkeratosis. The corneal involvement is often mistaken for herpes simplex virus (HSV) keratitis, which is a much commoner condition. CASE REPORT A previously healthy 10-month-old male infant was referred to Ophthalmology for acute onset photophobia. Bilateral dendritiform corneal lesions raised the suspicion for herpetic keratitis. Additionally, a papular, crusted lesion was found on his thumb after a few days of hospitalization, also raising concerns about HSV. The patient's clinical condition seemed to improve under intravenous acyclovir and supportive treatment. A conjunctival swab and crusted lesion on the thumb were tested for HSV using a polymerase chain reaction (PCR) technique, and both were negative. Nevertheless, given the clinical presentation and the favorable course of signs and symptoms, hospital discharge was planned with oral acyclovir. It was halted by an alternative diagnosis of autosomal recessive inborn error of metabolism, tyrosinemia type II, confirmed by elevated plasma tyrosine level and later by molecular analysis requested as a confirmatory investigation by the genetics medical team. CONCLUSIONS The corneal involvement in TYRII is often mistaken for HSV keratitis, and clinical course alone should not halt further investigations to rule out TYRII. Clinicians should suspect TYRII clinically when its characteristic ocular dendritiform lesions are present, namely in infancy or early childhood, and even in the absence of its typical cutaneous palmoplantar hyperkeratosis plaques.

Topics: Acyclovir; Administration, Intravenous; Child, Preschool; Corneal Ulcer; Humans; Infant; Keratitis, Herpetic; Male; Tyrosinemias

To describe a case of nivolumab-induced ulcerative keratitis rapidly recovering on topical steroid treatment and to determine changes in cytokine levels in the tear fluid caused by nivolumab.. We report a 34-year-old man receiving nivolumab for metastasized melanoma with severe dry eye symptoms and a persistent corneal epithelial defect. Levels of cytokine and matrix metalloproteinase in tear fluid were measured by multiplex immunoassays.. The corneal epithelial defect failed to recover for antiviral and lubrication therapy but resolved within 48 hours after topical steroid therapy was initiated. No recurrence of corneal ulceration was observed with intermittent topical steroid therapy during the remaining period of nivolumab treatment. No Sjögren disease-related autoantibodies were detected in the patient's serum. The levels of inflammatory cytokines and matrix metalloproteinases in the tear fluid were markedly elevated after nivolumab treatment.. Our observations suggest that nivolumab treatment induces a local autoimmune ocular surface disorder resulting in corneal ulceration that promptly resolves using steroid eye drops. The integrity of the corneal epithelial layer can be sustained using intermittent topical steroid therapy in patients receiving nivolumab.

Topics: Acyclovir; Adult; Antiviral Agents; Corneal Ulcer; Cytokines; Dry Eye Syndromes; Humans; Immune Checkpoint Inhibitors; Immunoassay; Male; Matrix Metalloproteinases; Melanoma; Nivolumab; Skin Neoplasms; Tears

We report the case of an immunocompetent male who presented with a limbal-adjacent scleritis and interstitial keratitis in the left eye. A few days later a new dendritiform ulcer in his right eye and bilateral progressive worsening with granulomatous uveitis in both eyes were observed. A thorough review of systems revealed positive serum IgM titles for herpes simplex virus.. In the context of a bilateral keratouveitis refractory to conventional treatment it is mandatory to rule out the herpetic origin based on the different forms of clinical presentation of this virus.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Corneal Opacity; Corneal Ulcer; Granuloma; Humans; Immunocompetence; Immunoglobulin M; Keratitis, Herpetic; Male; Scleritis; Simplexvirus; Uveitis; Virus Activation

Topics: Acyclovir; Adult; Antiviral Agents; Corneal Ulcer; Humans; Keratitis, Herpetic; Male

To report a case of bilateral Herpes simplex keratitis (HSK) masquerading as peripheral ulcerative keratitis (PUK).. A case of a 47-year-old female complaining of painful red eyes with a history of arthritis and anterior uveitis attacks with positive antinuclear antibodies (ANA). Biomicroscopy revealed PUK, stromal infiltrations and bilateral central corneal epithelial erosions. Slit-lamp examination disclosed +3 anterior chamber cells in both eyes.. Blood testing was positive for ANA. Herpes simplex virus (HSV) antigen was identified in both eyes using polymerase chain reaction (PCR). The management included topical prednisolone and acyclovir, as well as systemic valacyclovir. Improvement of epithelial corneal defects, PUK, and visual acuity was achieved gradually during the follow-up period.. Bilateral herpetic keratitis presenting as PUK is an extremely rare manifestation of herpetic disease. PUK can pose a diagnostic dilemma in cases with immune system dysregulation. Excluding infectious agents is mandatory for appropriate treatment.

Topics: Acyclovir; Antigens, Viral; Antiviral Agents; Corneal Ulcer; Diagnosis, Differential; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Keratitis, Herpetic; Middle Aged; Polymerase Chain Reaction; Prednisolone; Valacyclovir; Valine

Topics: Acyclovir; Adult; Biguanides; Corneal Stroma; Corneal Ulcer; Drug Therapy, Combination; Endothelium, Corneal; Eye Infections, Fungal; Female; Humans; Intraocular Pressure; Keratoplasty, Penetrating; Microsporidia; Microsporidiosis; Prednisolone; Visual Acuity

To describe the course and complications of varicella zoster ophthalmicus (VZO) in patients attending an eye clinic in a community with a high HIV seroprevalence.. Prospective cohort study of consecutive patients presenting to a tertiary hospital eye clinic with VZO.. Patients recruited in 2001 and 2002 received standardized initial topical and systemic management, which was then modified according to complications. Information on the course and complications of the disease was entered in a database prior to statistical analysis.. Information on 102 patients who had 250 visits to the eye clinic was collected. HIV serology was positive, negative, and unknown in 66, 22, and 14 patients, respectively. The most common complication was uveitis (40/102). Median delay from onset of rash to starting acyclovir was 5 days. Complications were present in 33 patients at the first visit. Complications were commoner in patients with positive Hutchinson's sign and were less common at CD4 counts <200. At CD4 counts, > or =200 HIV infection had little effect on the course and complications of VZO. Timing of commencement of Acyclovir therapy within or after 72 h had no demonstrable effect on the incidence of new complications.. In a resource-limited setting, patients with the following characteristics should have immediate ophthalmic assessment: symptoms suggesting ocular complications or the presence of Hutchinson's sign. All VZO patients should receive antiviral therapy at the first doctor's visit even if they present >72 h after onset of the rash.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Corneal Ulcer; Drug Administration Schedule; Female; Herpes Zoster Ophthalmicus; HIV Seroprevalence; Humans; Male; Middle Aged; Prospective Studies; South Africa; Uveitis

To report a case of bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis resulting in corneal perforation in a patient with pityriasis rubra pilaris.. Case report.. A 77-year-old female with pityriasis rubra pilaris was referred for a perforated corneal ulcer of the left eye. Cultures were positive in both eyes for Herpes simplex and in the left eye for Pseudomonas fluorescens and Staphylococcus aureus A microbiological cure was obtained with a combination of tectonic keratoplasty, fortified topical antibiotics, and systemic acyclovir.. Pityriasis rubra pilaris is a rare, inflammatory dermatologic disease that may predispose patients to bilateral Herpes simplex keratitis, secondary bacterial superinfection, and a tendency toward rapid stromal ulceration with risk of perforation.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cefazolin; Ceftazidime; Corneal Transplantation; Corneal Ulcer; Female; Humans; Keratitis; Keratitis, Herpetic; Pityriasis Rubra Pilaris; Pseudomonas fluorescens; Pseudomonas Infections; Staphylococcal Infections

To report 2 cases of herpes simplex keratitis misdiagnosed as rheumatoid arthritis (RA)-related peripheral ulcerative keratitis (PUK), where isolation of the herpes simplex virus (HSV) led to a complete modification in management.. This is a case report.. Two patients with RA presented with painful red right eyes. Ocular examination in both revealed an ulcer involving the peripheral cornea. The adjacent conjunctiva was infected, and the underlying sclera appeared inflamed. A diagnosis of corneal PUK secondary to RA was therefore made. The first patient had corneal scrapes taken for routine microbiological examination, which included polymerase chain reaction (PCR) for HSV. In the second patient, despite systemic immunosuppressive therapy, the ulcer progressed to involve deeper stroma and more central cornea. The conjunctiva adjacent to the ulcer was resected, and healthy conjunctival tissue was mobilized to cover the peripheral corneal ulcer. Resected conjunctival and corneal tissue was histopathologically assessed. In the first patient, PCR for HSV yielded a positive result. This prompted treatment with immediate systemic and topical acyclovir. The ulcer responded well to treatment. In the second patient, histopathological assessment and electron microscopy identified HSV. Treatment with topical trifluorothymidine and steroids was started, and a good recovery was made.. Treatment of PUK is with systemic immunosuppressive therapy, and such therapies have serious side effects. PUK may have an occult cause in RA, and a search for a secondary agent may be beneficial. In particular, occult HSV infection must be ruled out before commencing immunosuppressive therapy.

Topics: Acyclovir; Aged; Antiviral Agents; Arthritis, Rheumatoid; Cornea; Corneal Ulcer; Diagnosis, Differential; Diagnostic Errors; Female; Follow-Up Studies; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Male; Microscopy, Electron, Transmission; Middle Aged; RNA, Viral; Trifluridine

To evaluate the efficacy of multilayer amniotic membrane transplantation (AMT) combined with antivirus and corticosteroid drug to treat necrotizing herpes simplex stromal keratitis.. Thirteen patients (13 eyes) of necrotizing stromal keratitis were referred to Shandong Eye Institute and Qingdao Eye Hospital between January 2003 and April 2004. The course of disease was 3 - 22 months (mean 15 months). Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 weeks. Multilayer amniotic membrane transplantation was performed after excluding of bacterial and fungal infection by microbiologic studies including smears and cultures of necrotic corneal tissue and confocal microscope. Topical and systemic antiviral medications were given with adjuvant corticosteroid eyedrops postoperatively. We investigated the healing of corneal ulcer and improvement of stromal edema with slit lamp biomicroscope, the integrity of corneal defect with fluorescein staining, the migration of healthy corneal epithelial cells and transformation of amniotic membrane with confocal microscopy. All patients were followed up for 3 - 13 months (mean 10 months).. Corneal ulcer healed within 1 - 3 weeks postoperatively with negative fluorescein staining. Corneal stromal edema faded away within 1 month. Superficial amniotic membrane patches dissolved or shed on postoperative day 7 - 10, while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts. One of these grafts remained in situ more than 3 months. Confocal microscope examination indicated flat epithelial progenitor cells on the surface of residual amniotic membrane. Corneal transparence was achieved in 7 eyes, macula in 4 eyes and leucoma in 2 eyes 3 months after the operation. No recurrence of necrotizing stromal keratitis was occurred in 13 patients during the follow-up period.. Multilayer AMT combined with antivirus and corticosteroid treatment is an effective method to treat necrotizing herpes simplex stromal keratitis.

Topics: Acyclovir; Adult; Amnion; Antiviral Agents; Corneal Ulcer; Female; Follow-Up Studies; Glucocorticoids; Humans; Keratitis, Herpetic; Male; Middle Aged; Treatment Outcome

To report a case of atypical herpes simplex keratitis initially diagnosed as bacterial keratitis, in a contact lens wearer.. Case report of an 18-year-old woman using contact lenses who presented with pain, redness and gradual decrease in vision in the right eye. Examination revealed a paracentral large stromal infiltrate with a central 2-mm perforation. Corneal and conjunctival scrapings were collected for microbiological investigations. Corneal tissue was obtained following penetrating keratoplasty. Corneal scraping revealed no microorganisms. Giemsa stained smear showed multinucleated giant cells. Conjunctival, corneal scrapings and tissue were positive for herpes simplex virus - 1 (HSV) antigen. Corneal tissue was positive for HSV DNA by PCR.. Atypical HSV keratitis can occur in contact lens wearers. A simple investigation like Giemsa stain may offer a clue to the diagnosis.

Topics: Acyclovir; Adolescent; Antigens, Viral; Antiviral Agents; Azure Stains; Conjunctiva; Contact Lenses, Hydrophilic; Cornea; Corneal Ulcer; DNA, Viral; Female; Giant Cells; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Polymerase Chain Reaction; Rupture, Spontaneous

The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herpes varicella-zoster virus in patients with the acquired immunodeficiency syndrome (AIDS). Three AIDS patients with ocular herpes zoster infection (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral keratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy. Two of the patients responded well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis developed. The third patient had a recurrent episode of inflammation with PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella-zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct diagnosis and aggressive early long-term systemic antiviral treatment must be instituted to control inflammation, ulcer progression, and complications.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Ulcer; Herpes Zoster Ophthalmicus; Humans; Male; Ophthalmic Solutions; Prednisolone; Recurrence; Skin Diseases, Viral; Uveitis

The treatment of herpes simplex keratitis has ranged from simple debridement to the use of prototypic antiviral agents specific to the herpes family, such as acyclovir. The various treatment modalities for dendritic keratitis, for the most part, have been effective. However, in recent years numerous reports of antiviral-resistant strains of herpes simplex have appeared, particularly in immunocompromised patients receiving chronic acyclovir. Interferon has been proposed as a possible treatment adjunct in these cases. We report the case of a 46-year-old man on chronic immunosuppressive and acyclovir therapy after a renal transplant who developed ulcerative keratitis due to a strain of herpes simplex virus that was resistant to multiple antiviral agents both in vivo and in vitro. After 7 weeks without improvement on multiple treatment regimens, including trifluridine, vidarabine, debridement, and topical and systemic acyclovir, interferon alpha-2a was added to topical acyclovir therapy, and the keratitis quickly resolved. Topical interferon alpha-2a appears to be an effective treatment adjunct for refractory herpes simplex keratitis in patients with cell-mediated immune dysfunction and subsequent lack of endogenous interferon. Its value in nonimmunocompromised patients remains to be determined.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Cornea; Corneal Ulcer; Drug Resistance, Microbial; Drug Therapy, Combination; Herpesvirus 1, Human; Humans; Immunocompromised Host; Immunosuppression Therapy; Interferon alpha-2; Interferon-alpha; Keratitis, Herpetic; Male; Middle Aged; Ophthalmic Solutions; Recombinant Proteins

Dendritic keratitis occurred during oral acyclovir (ACV) therapy in a 60-year-old man. Corneal stromal edema and iritis were found at his first visit. Herpetic keratouveitis was suspected, based on clinical findings and previous history. Treatment with steroid eyedrops and ACV ointment was initiated. However, ACV [corrected] ointment was changed to oral ACV, since conjunctival ulcer occurred as an adverse effect of the ointment. Subsequently, he received long-term oral ACV medication and steroid eyedrops for recurrent keratitis. The fifth recurrence was also treated with oral ACV and steroid eyedrops. At this time, although the stromal keratitis had improved, there was an outbreak of dendritic keratitis. The lesion healed spontaneously after only a reduction in the steroid. The 50% effective dose (ED)50 of the isolated virus to ACV was 4.4 +/- 0.15 micrograms/ml (mean +/- SD), a level considered ACV-resistant in vitro. The clinical course of this case emphasizes that it is important to consider the route and duration of ACV administration and the use of steroids in the treatment of stromal keratitis or keratouveitis.

Topics: Acyclovir; Administration, Oral; Betamethasone; Cornea; Corneal Stroma; Corneal Ulcer; Drug Resistance, Microbial; Epithelium; Herpesvirus 1, Human; Humans; Keratitis, Dendritic; Male; Microbial Sensitivity Tests; Middle Aged; Ointments

To determine if acyclovir sodium prevents postoperative herpes simplex virus type 1 (HSV-1) recurrences, 21 rabbits harboring latent HSV-1 underwent uniocular autograft penetrating keratoplasty. All operated-on eyes were treated with topical and subconjunctival dexamethasone sodium phosphate. Ten of the 21 rabbits also received oral acyclovir (intravenous acyclovir was given at the time of surgery). Postoperatively, 9 (82%) of 11 operated-on eyes in rabbits not treated with acyclovir had positive HSV-1 ocular cultures. In acyclovir-treated rabbits, however, none of the 10 operated-on eyes had positive ocular cultures. In addition, 9 (82%) of 11 of the operated-on eyes had geographic ulcers develop in the non-acyclovir-treated rabbits, compared with 1 (10%) of 10 in the acyclovir-treated rabbits. Finally, stromal keratitis appeared in 5 (56%) of 9 of the operated-on eyes in non-acyclovir-treated rabbits and 1 (12%) of 8 of the operated-on eyes in acyclovir-treated rabbits. The results of this study indicate that acyclovir significantly lowered the incidence of HSV-1 ocular shedding, geographic ulceration, and stromal keratitis in a rabbit autograft penetrating keratoplasty model.

Topics: Acyclovir; Administration, Oral; Animals; Corneal Stroma; Corneal Transplantation; Corneal Ulcer; Female; Injections, Intravenous; Keratitis; Keratitis, Dendritic; Postoperative Complications; Rabbits; Recurrence; Simplexvirus; Tears

The anti-herpes simplex virus (HSV) effect and cytotoxicity of a new nucleoside analogue, 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG) in rabbit cornea were studied. In tests of the anti-HSV effect of DHPG, even 0.03% ointment, given 5 times per day for 2 days, prevented lesion formation. The preventive effect of DHPG was much stronger than that of acyclovir (ACV) or 5-iodo-2'-deoxyuridine (IDU). In tests on the therapeutic effect of DHPG against dendritic ulcers, 0.3% ointment, given 5 times per day for 4 days, had a dramatic therapeutic effect. The effect was stronger than that of 3% ACV or 0.5% IDU ointment. Application of 0.3%, 1% or 3% DHPG ointment to normal rabbit corneas, 5 times per day for 2 weeks resulted in no histopathological abnormalities. The above results show that DHPG is superior to ACV or IDU for treatment of HSV infections.

Topics: Acyclovir; Animals; Cornea; Corneal Ulcer; Ganciclovir; Keratitis, Dendritic; Rabbits; Simplexvirus

Topics: Acyclovir; Adolescent; Adult; Child; Corneal Ulcer; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis; Male; Middle Aged; Ointments; Prognosis

High-dosage Acyclovir therapy with intravenous applications of 3 X 15 mg/kg/day is discussed with reference to 2 patients with herpetic keratouveitis. The inflammations resolved after 7 days of treatment.

Topics: Acyclovir; Adult; Corneal Transplantation; Corneal Ulcer; Female; Humans; Infusions, Parenteral; Keratitis, Dendritic; Postoperative Complications; Recurrence; Uveitis; Visual Acuity