acyclovir and Glaucoma--Open-Angle

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

We quantitated herpes simplex virus (HSV) DNA in tear film obtained from 2 patients who developed herpetic epithelial keratitis (HEK) during treatment with latanoprost and a beta-blocker.. The patient in case 1 is a 77-year-old woman with bilateral open-angle glaucoma who had been treated with latanoprost and timolol for 11 months. She developed HEK in the right eye followed by HEK in the left eye 1 month later. Both eyes healed with administration of acyclovir. Ten months later, HEK recurred in the right eye. The patient in case 2 is a 45-year-old man with bilateral normal tension glaucoma who had been treated with latanoprost for 2 years. After concurrent treatment with nipradilol for 5 months, typical dendritic keratitis developed in the left eye. In both cases, a real-time PCR assay was used to quantify HSV-DNA in the tear film.. In the patient in case 1, 71 copies of the HSV genome were detected in the tear film obtained from the right eye at the time of presentation with HEK. After 1 week of treatment with topical acyclovir ointment, the corneal epithelial defects healed and the number of HSV genome copies present in the tear film fell below the sensitivity limit of the assay. In the patient in case 2, 7.0 x 10 copies of the HSV genome were detected in the tear film from the left eye. After 3 days of topical acyclovir ointment, it healed and the HSV genome in the tear film became undetectable.. Herpetic keratitis may occur during treatment with latanoprost and beta-blockers. The amount of HSV DNA detected in the tear film paralleled with the activity of the corneal lesion.

Topics: Acyclovir; Aged; Antihypertensive Agents; Antiviral Agents; DNA, Viral; Epithelium, Corneal; Female; Gene Dosage; Genome, Viral; Glaucoma, Open-Angle; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Male; Middle Aged; Polymerase Chain Reaction; Virus Activation; Virus Latency; Virus Replication