acyclovir and Iridocyclitis

To assess the benefit of adding oral acyclovir to a regimen of topical prednisolone phosphate and trifluridine for the treatment of iridocyclitis caused by herpes simplex virus (HSV).. Patients with HSV iridocyclitis were enrolled in a multicenter controlled clinical trial supported by the National Eye Institute, Bethesda, Md, and randomly assigned to receive a 10-week course of either oral acyclovir, 400 mg, 5 times daily, or oral placebo in conjunction with regimens of topical trifluridine and a topical corticosteroid. Follow-up examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 26 weeks after enrollment in the trial. Treatment failure was defined as a persistence or worsening of ocular inflammation, withdrawal of medication because of toxicity, or a request by the patient to withdraw from the trial for any reason. The trial was stopped because of slow recruitment after only 50 of the originally planned 104 patients were enrolled in more than 4 years.. A treatment failure occurred in 11 (50%) of the 22 patients in the acyclovir-treated group and in 19 (68%) of the 28 patients in the placebo group. Compared with the placebo group, the adjusted rate ratio for a treatment failure in the acyclovir-treated group during the 10-week treatment period was 0.43 (90% confidence interval, 0.18-1.02; P = .06, 1-tailed) and during the 16-week follow-up period (10-week treatment period plus 6-week observation period) was 0.60 (90% confidence interval, 0.29-1.25; P = .13, 1-tailed in a proportional hazards model). The treatment effect seemed slightly greater when only the patients with a persistence or worsening of ocular HSV disease were considered as treatment failures (ie, excludes terminations because of toxic effects of the drug and patients who requested to withdraw from the trial). By life-table analysis, similar results were obtained; the possible benefit of acyclovir became apparent after the first 3 weeks of follow-up.. While the number of patients recruited in this trial was too small to achieve statistically conclusive results, the trend in the results suggests a benefit of oral acyclovir in the treatment of HSV iridocyclitis in patients receiving topical corticosteroids and trifluridine prophylaxis.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Anti-Inflammatory Agents; Antiviral Agents; Corneal Stroma; Female; Follow-Up Studies; Herpes Simplex; Herpesvirus 1, Human; Humans; Iridocyclitis; Keratitis, Herpetic; Male; Middle Aged; Ophthalmic Solutions; Patient Compliance; Prednisolone; Treatment Failure; Treatment Outcome; Trifluridine

Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis.. The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks.. Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis.. Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Endothelium, Corneal; Female; Humans; Iridocyclitis; Keratitis, Dendritic; Keratitis, Herpetic; Male; Prednisolone; Recurrence; Risk Factors; Trifluridine

We examined the recurrence rate of herpetic uveitis (HU) in 13 patients (group A) treated prophylactically with long-term systemic acyclovir (600-800 mg/day) and compared it with that of 7 patients with no prophylactic therapy (group B). HU was diagnosed on the basis of a history of dendritic or disciform keratitis accompanied by iridocyclitis and iris atrophy. The study population consisted of 12 men and 8 women with a mean age at onset of uveitis of 52.9 years (range 19-78 years). All patients were followed for at least 8 months. The mean follow-up time of patients on long-term oral acyclovir was 26.0 months. In this group, only one patient experienced a single recurrent episode of uveitis while on 600-800 mg/day of acyclovir therapy; two additional patients had recurrence of HU within 16.2 months after the acyclovir dose was tapered below 600 mg/day. In striking contrast, 16 recurrences occurred in the 7 patients of group B (p < 0.05). Of these, the initial recurrence occurred within an average of 4.3 months following cessation of therapy. There was a significant difference (p < 0.05) in the mean recurrence-free interval between patients in group A (24.6 months) and those in group B (3.4 months). Herpetic uveitis is a serious ocular disease in which recurrence of inflammation results in severe ocular complications. The long-term use of oral acyclovir may be of benefit in the prevention of recurrences, and hence may reduce the blinding complications of this disease. Efforts at completing a randomized, placebo-controlled trial on this matter by the Herpes Epithelial Disease Study Group were unsuccessful due to insufficient patient recruitment.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Atrophy; Female; Humans; Iridocyclitis; Iris; Keratitis, Dendritic; Keratitis, Herpetic; Male; Middle Aged; Recurrence; Treatment Outcome; Uveitis; Visual Acuity

The Herpetic Eye Disease Study (HEDS) includes three double-masked, placebo-controlled clinical trials for potentially blinding herpes simplex virus (HSV) eye infections. One study compares a tapering dosage of topical prednisolone or placebo eye drops for HSV stromal keratitis (HEDS-SKN). Two other trials compare oral acyclovir to placebo capsules for HSV stromal keratitis (HEDS-SKS) or iridocyclitis (HEDS-IRT) in patients on a tapering dosage of topical prednisolone drops. All medications are administered for 10 weeks. Outcome is judged by time to recurrent disease or treatment failure. This paper presents the design, estimated sample size and recruitment as of July 25, 1990.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Clinical Protocols; Corneal Stroma; Double-Blind Method; Drug Administration Schedule; Humans; Iridocyclitis; Keratitis, Dendritic; Placebos; Prednisolone; Prognosis; Research Design

To report ocular manifestations associated with chikungunya.. Retrospective, nonrandomized, observational case series.. Nine chikungunya patients with ocular involvement.. All patients with chikungunya infection presenting with ocular complaints from September 2006 to October 2006 were included in the study. The infection was confirmed by demonstration of chikungunya immunoglobulin M antibody in sera of all patients. All patients underwent an ophthalmic examination including fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography. Positive ocular changes were recorded and tabulated.. Characteristics, frequency, and locations of ocular lesions found in the participants.. There were 9 patients with ocular lesions; 1 had nodular episcleritis, 5 presented with acute iridocyclitis, and 3 had retinitis. Four to 12 weeks before the development of ocular manifestations, all of these patients had fever. Although there were no specific changes of iridocyclitis that were diagnostic of the fever, the retinal changes were consistent with viral retinitis. All patients recovered from the infection with relatively good vision.. It appears that iridocyclitis and retinitis are the most common ocular manifestations associated with chikungunya, with a typically benign clinical course. Less frequent ocular lesions include episcleritis. All the patients responded well to the treatment with preservation of good vision. To the best of our knowledge, similar ocular manifestations associated with chikungunya infection have not been reported. In the differential diagnosis of iridocyclitis and retinitis with features suggestive of a viral infection, the entity of chikungunya-associated ocular changes should be considered in the regions affected by the epidemic.

Topics: Acyclovir; Adult; Aged; Alphavirus Infections; Antibodies, Viral; Antiviral Agents; Chikungunya virus; Diclofenac; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Humans; Immunoglobulin M; Iridocyclitis; Male; Microscopy, Confocal; Middle Aged; Prednisolone; Retinitis; Retrospective Studies; Scleritis; Tomography, Optical Coherence; Visual Acuity

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Fluorescein Angiography; Genome, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intraocular Pressure; Iridocyclitis; Male; Phlebitis; Polymerase Chain Reaction; Prednisolone; Retinal Diseases; Retinal Vein; Visual Acuity

To report a case of zoster sine herpete with bilateral ocular involvement.. Case report.. A 65-year-old man showed bilateral iridocyclitis with sectoral iris atrophy and elevated intraocular pressure unresponsive to steroid treatment. No cutaneous eruption was manifest on the forehead. A target region of varicella-zoster virus DNA sequence was amplified from the aqueous sample from the left eye by polymerase chain reaction. Bilateral iridocyclitis resolved promptly after initiation of systemic and topical acyclovir treatment. Secondary glaucoma was well controlled by bilateral trabeculectomy.. Zoster sine herpete should be considered and polymerase chain reaction performed on an aqueous sample to detect varicella-zoster virus DNA for rapid diagnosis whenever anterior uveitis accompanies the characteristic iris atrophy, even in the case of bilateral involvement.

Topics: Acyclovir; Aged; Antiviral Agents; Atrophy; DNA Primers; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intraocular Pressure; Iridocyclitis; Iris; Male; Ocular Hypertension; Polymerase Chain Reaction; Trabeculectomy; Visual Acuity

Topics: Acute Disease; Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Dexamethasone; Diagnosis, Differential; Female; HLA-B27 Antigen; Humans; Intraocular Pressure; Iridocyclitis; Keratitis, Herpetic; Methylprednisolone; Mydriatics; Rheumatic Diseases; Toxoplasmosis, Ocular; Uveitis, Anterior

Keratitis, retinitis and secondary cataract are well known complications of ocular herpes simplex infection. We report on a case of herpetic keratouveitis and cataract. Acute and inflammatory pathogenesis of cataract formation resemble a phacoanaphylactic reaction.. A 15-year-old girl with recurrent herpes keratitis was referred for acute spontaneous cataract formation accompanied by iridocyclitis and hypotony. Visual acuity was decreased from 0.4 to light projection. During cataract extraction the anterior chamber was tabbed for immunological analysis. The thickened anterior lens capsule was examined by light microscopy. We found a significant local synthesis of herpes antibodies in the aqueous. Histologically the lens capsule depicted a defect and a granulomatous inflammatory infiltrate towards the basal membrane material. The specimen was not suitable to judge on eventual additional phacoanaphylaxis. After cataract extraction and systemic acyclovir and corticosteroids the keratouveitis subsided. Visual acuity improved to 0.4, but was limited by the disciform corneal scar.. The granulomatous response towards lens capsule shown here, resembles the granulomatous reaction towards Descemet's membrane in advanced herpetic corneal ulcer. We speculate on the pathogenesis of the lens capsule defect as a, so far unknown, herpes-associated autoimmun response against the basal membrane material of the lens. The acuteness of cataract formation may be a consequence of contact of aqueous with lens fibres. Additional phacoanaphylaxis combined with secondary glaucoma is possible.

Topics: Acyclovir; Adolescent; Anterior Chamber; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Cataract; Cataract Extraction; Combined Modality Therapy; Cornea; Female; Humans; Iridocyclitis; Keratitis, Herpetic; Lens Capsule, Crystalline; Simplexvirus

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Aqueous Humor; Base Sequence; Dexamethasone; DNA Primers; DNA, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Iridocyclitis; Molecular Sequence Data; Ophthalmic Solutions; Polymerase Chain Reaction

The optimal management of herpes simplex stromal keratitis and uveitis is controversial. Thirty-two patients with presumptive herpetic anterior uveitis without active corneal inflammation received 3% acyclovir ophthalmic ointment five times daily and acyclovir 200mg orally five times a day. Eight of 18 patients (44.4%) who had received corticosteroids deteriorated over the first five days of therapy; one of 14 patients (7.1%) without previous corticosteroid use worsened during this time (P less than .05). The mean healing time was similar in these two groups. These results suggest that antiviral therapy may be first-line treatment in patients with herpetic keratouveitis who have not received corticosteroids.

Topics: Acyclovir; Administration, Oral; Adult; Female; Humans; Iridocyclitis; Male; Ointments; Steroids; Stomatitis, Herpetic; Uveitis, Anterior