acyclovir and Iritis

Herpes simplex virus (HSV) is a leading cause of chronic infectious ocular disease in the United States. The morbidity from recurrent herpetic episodes is high, and the resultant corneal scarring may require penetrating keratoplasty for visual rehabilitation. Effective treatments for acute episodes of HSV have been verified by early Herpetic Eye Disease Study (HEDS) trials. The recent HEDS trial on the efficacy of oral acyclovir as prophylaxis against recurrent stromal keratitis represents the first report of a treatment likely to reduce long-term scarring from herpetic disease. This article reviews all the HEDS trials and the implications of their findings for the management of patients with ocular HSV.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Corneal Stroma; Humans; Iritis; Keratitis, Herpetic; Prednisolone; Randomized Controlled Trials as Topic; Recurrence; Trifluridine

Determinants of the natural history of recurrent herpes simplex virus (HSV) keratitis have not been consistently established. We assessed how previous HSV eye disease affects the risk of recurrent HSV keratitis and evaluated whether demographic and other variables play any predictive role.. Three hundred forty-six patients in the placebo group of the Herpetic Eye Disease Study's Acyclovir Prevention Trial who had experienced an episode of HSV eye disease in the previous year were followed up for 18 months. Recurrences were categorized according to the type of involvement. Relative rates of recurrence were compared for categories of demographic variables, types and number of previous ocular HSV episodes, previous nonocular HSV infection, and month of the year.. Fifty-eight (18%) of the 346 patients developed epithelial keratitis and 59 (18%) developed stromal keratitis during the 18 months of follow-up. Previous epithelial keratitis did not significantly affect the risk of epithelial keratitis (p = 0.84). In contrast, previous stromal keratitis increased the risk of stromal keratitis 10-fold (p < 0.001), and the risk was strongly related to the number of previous episodes (p < 0.001). Age, gender, ethnicity, and nonocular herpes were not significantly associated with recurrences, and no seasonal effects were observed.. Among patients who experienced active ocular HSV disease in the previous year, a history of epithelial keratitis was not a risk factor for recurrent epithelial keratitis. In contrast, previous, especially multiple, episodes of stromal keratitis markedly increased the probability of subsequent stromal keratitis.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Blepharitis; Child; Conjunctivitis, Viral; Corneal Stroma; Epithelium, Corneal; Female; Herpesvirus 1, Human; Humans; Iritis; Keratitis, Herpetic; Male; Middle Aged; Recurrence; Risk Factors

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Clinical Trials as Topic; Humans; Iritis; Keratitis, Herpetic; Recurrence

Long-term treatment with antiviral agents has been shown to prevent recurrences of genital and orofacial herpes simplex virus (HSV) disease, but it is uncertain whether prophylactic treatment can prevent recurrences of ocular HSV disease.. We randomly assigned 703 immunocompetent patients who had had ocular HSV disease within the preceding year to receive 400 mg of acyclovir or placebo orally twice daily. The study outcomes were the rates of development of ocular or nonocular HSV disease during a 12-month treatment period and a 6-month observation period.. The cumulative probability of a recurrence of any type of ocular HSV disease during the 12-month treatment period was 19 percent in the acyclovir group and 32 percent in the placebo group (P<0.001). Among the 337 patients with a history of stromal keratitis, the most common serious form of ocular HSV disease, the cumulative probability of recurrent stromal keratitis was 14 percent in the acyclovir group and 28 percent in the placebo group (P=0.005). The cumulative probability of a recurrence of nonocular (primarily orofacial) HSV disease was also lower in the acyclovir group than in the placebo group (19 percent vs. 36 percent, P<0.001). There was no rebound in the rate of HSV disease in the six months after treatment with acyclovir was stopped.. After the resolution of ocular HSV disease, 12 months of treatment with acyclovir reduces the rate of recurrent ocular HSV disease and orofacial HSV disease. Long-term antiviral prophylaxis is most important for patients with a history of HSV stromal keratitis, since it can prevent additional episodes and potential loss of vision.

Topics: Acyclovir; Antiviral Agents; Blepharitis; Conjunctivitis; Female; Humans; Incidence; Iritis; Keratitis, Herpetic; Male; Middle Aged; Secondary Prevention; Treatment Outcome

To evaluate the efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis caused by herpes simplex virus (HSV).. Patients with HSV epithelial keratitis of 1-week or less duration were treated with topical trifluridine and were randomly assigned to receive a 3-week course of oral acyclovir, 400 mg 5 times a day (hereafter referred to as the acyclovir group), or placebo (hereafter referred to as the placebo group). The development of HSV stromal keratitis or iritis was assessed during 12 months of follow-up.. Stromal keratitis or iritis developed in 17 (11%) of the 153 patients in the acyclovir group and in 14 (10%) of the 134 patients in the placebo group. Compared with the placebo group, the adjusted rate ratio for the development of stromal keratitis or iritis in the acyclovir group was 1.16 (95% confidence interval, 0.56-2.43). The development of stromal keratitis or iritis was more frequent in patients with a history of HSV stromal keratitis or iritis than in those without such a history (23% vs 9%; P = .01).. For patients with HSV epithelial keratitis treated with topical trifluridine, no apparent benefit of a 3-week course of oral acyclovir in preventing HSV stromal keratitis or iritis was seen during the subsequent year. The 1-year rate of development of stromal keratitis or iritis was lower than previously reported in the literature, except in patients with a history of HSV stromal keratitis or iritis.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Cornea; Corneal Stroma; Epithelium; Female; Follow-Up Studies; Herpes Simplex; Humans; Iritis; Keratitis; Male; Middle Aged; Prognosis; Recurrence

A 21-year-old woman had crosslinking for keratoconus in the right eye; the left eye was scheduled for penetrating keratoplasty. Five days postoperatively, she presented with geographic epithelial keratitis and iritis. Analysis of tear samples by polymerase chain reaction confirmed the diagnosis. The patient was treated with oral steroids and acyclovir, with significant improvement. Two months postoperatively, the visual acuity was improved and there was no evidence of herpetic disease recurrence. Crosslinking can induce herpetic keratitis with iritis even in patients with no history of herpetic disease. Early diagnosis and proper treatment are essential for a favorable outcome.

Topics: Acyclovir; Adult; Collagen; DNA, Viral; Drug Therapy, Combination; Female; Glucocorticoids; Herpesvirus 1, Human; Humans; Iritis; Keratitis, Herpetic; Keratoconus; Photosensitizing Agents; Polymerase Chain Reaction; Riboflavin; Tears; Ultraviolet Rays; Virus Activation; Visual Acuity

To evaluate the effectiveness of more than 12 months of oral acyclovir therapy in reducing recurrences of ocular herpes simplex virus.. We retrospectively compared ocular herpes simplex virus recurrence in 2 groups of patients. In group 1, patients used oral acyclovir for at least 12 months and then discontinued the treatment. In group 2, patients received the treatment for at least 18 months. We compared recurrences when both groups were using acyclovir (period 1) and when only group 2 was receiving the drug (period 2). Statistical analysis was performed with the t test, chi2 test, and Kaplan-Meier method.. Group 1 had 18 patients and a mean +/- SD follow-up of 45.2 +/- 22.2 months. Group 2 had 22 patients and a mean +/- SD follow-up of 42.4 +/- 30.2 months. Six patients (33%) in group 1 and 4 patients (18%) in group 2 had recurrence in period 1 (P =.3). In period 2, 14 patients (78%) in group 1 and 8 patients (36%) in group 2 had recurrence (P =.01). Mean +/- SD recurrence-free survival in period 2 was 15.3 +/- 5.5 months in group 1 and 37.3 +/- 6.3 months in group 2 (P =.001).. Long-term oral acyclovir use seems to remain effective in decreasing the number of ocular herpes simplex virus recurrences beyond 12 months.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Blepharitis; Conjunctivitis, Viral; Disease-Free Survival; Female; Follow-Up Studies; Herpes Simplex; Humans; Iritis; Keratitis, Herpetic; Male; Middle Aged; Retrospective Studies; Secondary Prevention

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Glaucoma; Herpes Simplex; Herpesvirus 1, Human; Humans; Intraocular Pressure; Iritis; Male; Middle Aged; Pigment Epithelium of Eye; Uveitis, Anterior

To investigate the ocular complications of herpes zoster ophthalmicus in patients with human immunodeficiency virus (HIV) infection.. This was a retrospective cohort study of 48 HIV-infected patients (48 eyes) treated at San Francisco General Hospital for herpes zoster ophthalmicus from December 1985 through March 1994.. All patients were initially treated with either intravenous or oral acyclovir. The median CD4 lymphocyte count at diagnosis was 48 per mm3 (range, 2 to 490 per mm3). Fifteen patients (31%) had mild or no ocular involvement. Seventeen patients (35%) had stromal keratitis, mostly mild, and two (4)% developed chronic infectious pseudodendritic keratitis. Twenty-four study patients (50%) had iritis, but only three (6%) had elevations in intraocular pressure. Two patients (4%) developed postherpetic neuralgia, and two others (4%) had zoster-associated central nervous system disease. Only two patients (4%) developed necrotizing retinitis, both in the form of the progressive outer retinal necrosis syndrome.. Excluding the patients with retinitis and central nervous system disease, the rate of sight-threatening complications in our series was lower than expected. Almost one third of study patients had no ocular complications or only mild surface epithelial disease. Although the relatively low incidence of sight-threatening disease in our study population may have been a consequence of aggressive management with acyclovir, chronic infectious pseudodendritic keratitis, retinitis, and central nervous system disease, complications of ophthalmic zoster whose pathogenesis is largely a consequence of active viral replication, were particularly devastating and difficult to manage.

Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cohort Studies; Eye Diseases; Female; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Iritis; Keratitis; Male; Middle Aged; Neuralgia; Retinal Necrosis Syndrome, Acute; Retrospective Studies

The tentative diagnosis of herpetic anterior uveitis was confirmed by means of an analysis of the aqueous humor employing the electron-microscopic negative contrast method; Acyclovir therapy was subsequently administered. The case is described and routine application of the method is discussed.

Topics: Acyclovir; Adult; Aqueous Humor; Fluorescent Antibody Technique; Humans; Iris; Iritis; Keratitis, Dendritic; Male; Microscopy, Electron; Ophthalmic Solutions; Simplexvirus

Stromal keratitis and associated iritis were produced in rabbit eyes with the intrastromal injection of live herpes simplex virus. Treatment with 3% acyclovir and 2% trifluridine eye ointments was initiated one day after infection and continued for five consecutive days. These therapies significantly suppressed the development of keratouveitis compared with a placebo ointment. The suppressive action of trifluridine ointment on keratouveitis was significantly more pronounced than that of acyclovir ointment.

Topics: Acyclovir; Administration, Topical; Animals; Iritis; Keratitis, Dendritic; Ointments; Rabbits; Thymidine; Trifluridine; Uveitis

A promising new nucleoside analog, 9-[[2-hydroxy-1-(hydroxymethyl)ethoxy] methyl]-guanine (BW759), which is structurally similar to acyclovir, was tested against acute herpetic keratitis in the rabbit ocular model. Topical 1-0.1% BW759 given 3-5x per day gave beneficial results in that corneal epithelial involvement, conjunctivitis, iritis, and corneal clouding were reduced even when chemotherapy was initiated at 3 days postinoculation. Under the same conditions, topical BW759 therapy gave slightly better results than acyclovir, and both were better than idoxuridine therapy. Mortality rate and colonization of the trigeminal ganglia by HSV-1 were unaffected by BW759 therapy. Duration of virus, shed into the tear film was reduced by BW759.

Topics: Acyclovir; Animals; Antiviral Agents; Chemical Phenomena; Chemistry; Conjunctivitis; Corneal Opacity; Drug Evaluation, Preclinical; Follow-Up Studies; Ganciclovir; Herpes Simplex; Idoxuridine; Iritis; Keratitis, Dendritic; Male; Neuritis; Ointments; Rabbits; Time Factors; Trigeminal Nerve

Twenty-five patients with long standing deep stromal herpetic keratitis and iritis were treated with acyclovir (3%) ointment and corticosteroids. All patients healed in about two to four weeks, independent of the duration of the keratitis before acyclovir treatment and independent of the antiviral medication given previously. Recurrences could not be prevented by acyclovir treatment. No serious side effects of acyclovir were noted.

Topics: Acyclovir; Administration, Topical; Adrenal Cortex Hormones; Humans; Iritis; Keratitis, Dendritic; Recurrence; Visual Acuity