acyclovir and Uveitis--Anterior

To define a clinically tailored therapeutic strategy for the treatment of viral anterior uveitis (VAU).. A PubMed search spanning the past 5 years was conducted using the MesH-terms "viral anterior uveitis" and "therapy.". The herpes simplex virus (HSV), the varicella zoster virus (VZV), and the cytomegalovirus (CMV) are the predominant pathogens in VAU. Other viruses, including rubella, chikungunya, and zika, have been linked with distinct forms of the disease. Depending on the causative agent and the host immunocompetence, the mainstay treatment for suspected VAU is a combination of topical or systemic antivirals and topical corticosteroids, supplemented with cycloplegics and intraocular-pressure-lowering medication.. Oral acyclovir, valacyclovir, and famciclovir are the mainstay of treatment for HSV- and VZV-induced infections. Brivudin serves as an alternative in insufficiently responsive cases. CMV-induced infections respond well to valganciclovir. A 3- to 12-month course of prophylactic treatment against recurrences is worth considering.

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chikungunya Fever; Cytomegalovirus Infections; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Rubella; Uveitis, Anterior; Valacyclovir; Zika Virus Infection

A 25-year-old woman presented with redness, pain, and diminution of vision that occurred 2 weeks after microkeratome-assisted laser in situ keratomileusis (LASIK). On presentation, corneal edema, Descemet membrane folds, keratic precipitates, stromal infiltrates, and flap necrosis were observed. Delayed post-LASIK microbial keratitis was diagnosed. The patient had no history of ocular herpes. Culture and scraping showed no organisms. Immunofluorescence stain was positive for the herpes simplex virus antigen. The patient was started on oral valacyclovir, and progress was monitored through serial clinical photographs and anterior segment optical coherence tomography. Resolution began within 3 days of initiating treatment and was complete in 4 weeks.

Topics: Acyclovir; Administration, Oral; Adult; Antigens, Viral; Antiviral Agents; Corneal Stroma; Female; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Myopia; Necrosis; Postoperative Complications; Simplexvirus; Surgical Flaps; Tomography, Optical Coherence; Uveitis, Anterior; Valacyclovir; Valine

To determine the efficacy of systemic acyclovir in decreasing complications and improving the outcome of penetrating keratoplasty for herpes simplex virus (HSV) keratitis.. Retrospective study of 53 primary penetrating keratoplasties for HSV keratitis at an eye hospital from January 1, 1989, through December 31, 1996. Medical records were analyzed for history of HSV keratitis, preoperative neovascularization, and disease activity. Postoperative use of acyclovir, recurrence of HSV keratitis, rejection, uveitis or edema, and graft failure were evaluated.. Twenty-four patients (mean +/- SD follow-up, 44.7 +/- 32.6 months) received no acyclovir and were compared with 20 patients, (mean +/- SD follow-up, 28.8 +/- 16.7 months), who received 400 mg acyclovir twice a day for at least 1 year. No patient in the acyclovir group had a recurrence of dendritic keratitis in the first year compared with 5 (21%) of the patients who did not receive acyclovir (P = .03). No patient had graft failure in the acyclovir group compared with 4 (17%) in the group without acyclovir after 1 year of follow-up (P = .06).. Postoperative systemic acyclovir therapy after penetrating keratoplasty for HSV keratitis is associated with a reduced rate of recurrent HSV dendritic keratitis and possible graft failure at 1 year of follow-up.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Corneal Edema; Drug Evaluation; Female; Follow-Up Studies; Graft Rejection; Herpesvirus 1, Human; Humans; Keratitis, Dendritic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Uveitis, Anterior; Visual Acuity

Poor systemic absorption has limited the efficacy of early oral acyclovir in herpes zoster ophthalmicus (HZO). Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir. Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complications (p < 0.02) and anterior uveitis was significantly more frequent (p < 0.01) and severe (p < 0.01). Corneal hypoaesthesia was significantly more frequently (p < 0.05) and severe (p < 0.02) at 1 month. From 2 weeks patients receiving ointment were more likely to have pain and at all times their pain was more severe, but these differences were not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis; Male; Middle Aged; Pain Measurement; Scleritis; Treatment Outcome; Uveitis, Anterior

Reports on the natural history of herpes zoster ophthalmicus stress its high morbidity related to vicious scars on eyelids, ocular complications, and post-herpetic neuralgia. Early treatment with oral acyclovir is effective, but the optimal duration of treatment has not been defined.. The authors performed a bicentric, prospective, randomized, double-masked study of 86 patients with acute herpes zoster ophthalmicus, within 72 hours of skin eruption, who received oral acyclovir (800 mg 5 times daily), either for 7 days (plus 7 days oral placebo) or for 14 days. All patients concomitantly received ophthalmic 3% acyclovir ointment; follow-up was at least 6 months.. Statistical analyses of subjective symptoms, skin lesions, and ocular complications showed no significant differences between the groups, suggesting that a 7-day course of treatment was sufficient. Drug tolerance was good. Pooled data from both groups corroborated earlier reports that prompt treatment with oral acyclovir reduces the severity of the skin eruption, the incidence and severity of late ocular manifestations, and the intensity of postherpetic neuralgia. At 6 months, late ocular inflammatory complications were seen in 29.1% of our 86 patients, versus 50% to 71% of untreated patients described by others. Only 13% of our patients experienced post-herpetic neuralgia, which in no case required the use of analgesics.. The authors believe it is not useful to prolong treatment with 800 mg of oral acyclovir 5 times daily for more than 7 days in herpes zoster ophthalmicus. This study confirms the efficacy of oral acyclovir not only against skin lesions and ocular complications, but also against postherpetic neuralgia in herpes zoster ophthalmicus.

Topics: Acyclovir; Administration, Oral; Aged; Double-Blind Method; Drug Tolerance; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Longitudinal Studies; Male; Middle Aged; Placebos; Prospective Studies; Uveitis, Anterior

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

To describe and to compare the clinical manifestation and laboratory test results of herpetic anterior uveitis (HAU) caused by Herpes simplex virus (HSV) and varicella-zoster virus (VZV).. A retrospective, observational study on patients diagnosed with HAU. Etiology, clinical features, ocular complications, and recurrences of the infection were evaluated as main clinical parameters. The aqueous Interleukin-8 (IL-8) level was also measured to assess the intraocular inflammation.. Thirty-two eyes (32 patients) were involved. Among all involved cases, 24 had VZV-AU and 8 had HSV-AU. Common clinical features of HAU included the presence of KPs (90.6%), distorted pupil (83.3%), Iris atrophy (71.9%) and corneal edema (50%). The intraocular fluid analysis showed higher viral load and IL-8 level in VZV-AU.. Compared with HSV-AU, the intraocular inflammation was more severe in VZV-AU. The intraocular fluid analysis was valuable for the etiological diagnosis and the evaluation of disease severity.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Asian People; China; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Interleukin-8; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Simplexvirus; Uveitis, Anterior; Valacyclovir; Viral Load; Visual Acuity; Young Adult

To describe the reactivation of Varicella-Zoster Virus Anterior Uveitis after YAG laser peripheral iridotomy.. A 69-year-old woman referred with unilateral, anterior uveitis associated with decreased corneal sensation and increased intraocular pressure 5 days after YAG laser peripheral iridotomy. The impression of herpetic anterior uveitis reactivation followed by YAG PI confirmed by polymerase chain reaction of aqueous humor by detecting varicella zoster virus. Treatment with oral acyclovir and topical corticosteroid and cycloplegic resulted control of both the intraocular inflammation and pressure.. YAG PI may be a risk factor for reactivation of herpetic anterior uveitis. Prophylaxis with acyclovir may be necessary after YAG PI to prevent reactivation of herpetic anterior uveitis.

Topics: Acyclovir; Aged; Antiviral Agents; Aqueous Humor; Eye Infections, Viral; Female; Herpesvirus 3, Human; Humans; Iris; Lasers, Solid-State; Latent Infection; Polymerase Chain Reaction; Uveitis, Anterior; Varicella Zoster Virus Infection

We report on the case of a young immunocompetent female patient with parainfectious optic neuritis and macular inflitrate due to Neisseria meningitidis B meningitis.. Case report RESULTS: A 22-year-old female patient was admitted to the emergency department for intensive care treatment with a strong suspicion of meningitis. Clinical and serological parameters were indicative of a bacterial genesis of the meningitis. By analysis of the cerebrospinal fluid (CSF) Neisseria meningitidis type B could be detected. Subjective and objective symptoms could be improved by immediate intravenous administration of antibiotics; however, 1 day before discharge the patient complained of a sudden left-sided, painful loss of vision with extreme photophobia. The ophthalmoscopic examination revealed profound ciliary injection with slight anterior uveitis and papilledema with macular infiltration and diffuse petechiae-like retinal hemorrhage. After exclusion of viral proliferation in the CSF systemic steroid therapy was carried out together with continuation of antibiotic therapy and the eye was treated with local steroids and mydriatics. This resulted in healing of the ocular inflammation and partial recovery of vision.. The painful loss of vision in this patient is probably due to parainfectious optic neuritis with macular infiltrate from Neisseria meningitidis B meningitis, which is an unusual course. Despite the rarity of this disease the complication of a parainfectious inflammation of the optic nerve should be considered and appropriate steps taken when the corresponding symptoms occur.

Topics: Acyclovir; Adrenal Cortex Hormones; Ceftriaxone; Female; Humans; Infusions, Intravenous; Macula Lutea; Meningitis, Meningococcal; Mydriatics; Neisseria meningitidis, Serogroup B; Ophthalmic Solutions; Ophthalmoscopy; Optic Neuritis; Papilledema; Retinal Diseases; Uveitis, Anterior; Young Adult

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Gene Dosage; Glucocorticoids; Humans; Keratitis, Herpetic; Male; Middle Aged; Prednisolone; Real-Time Polymerase Chain Reaction; Simplexvirus; Uveitis, Anterior; Valacyclovir; Valine

A 20-year-old man presented with a recurrent episode of herpetic keratouveitis in his right eye. The patient was treated with oral acyclovir and topical steroids. One week later the patient reported a sudden diminution of vision. Slitlamp biomicroscopy revealed the presence of a central anterior capsular defect and anterior subcapsular cataract. Dosage of steroids was temporarily increased and progression of cataract monitored. Subsequently, the anterior chamber reaction decreased and steroids were tapered.

Topics: Acyclovir; Adrenal Cortex Hormones; Anterior Capsule of the Lens; Antiviral Agents; Cataract; Herpes Simplex; Humans; Keratitis, Herpetic; Male; Recurrence; Uveitis, Anterior; Vision Disorders; Young Adult

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child; Female; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Recurrence; Retinal Vasculitis; Uveitis, Anterior; Virus Activation; Visual Acuity

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Cell Count; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Humans; Male; Prednisolone; Uveitis, Anterior; Valacyclovir; Valine; Visual Acuity

This retrospective study was designed to estimate the cumulative incidence of glaucoma in viral uveitis. Seventy-six consecutive patients with viral stromal keratouveitis were divided into two groups according to the etiologic agents herpes simplex virus (HSV) keratouveitis (n = 58) and herpes zoster virus (HZV) keratouveitis (n = 18). The groups were evaluated for the incidence and prognosis of ocular hypertension. Etiologic agents were determined with the help of clinical observation supported by the polymerase chain reaction (PCR) of aqueous humor. All patients received oral acyclovir therapy for at least six months and topical prednisolone in tapered doses. There was no significant difference in the recurrences of HSV and varicella zoster virus (VZV) keratouveitis between groups (P = 0.431). The total incidence of secondary glaucoma was 13.1%. Most of the patients responded to antiviral and antiglaucomatous therapy. Trabeculectomy with mitomycin C was performed in only two patients. Secondary glaucoma can be regarded as a frequent complication of viral uveitis. As it has a good prognosis, surgical intervention is rarely required.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Female; Glaucoma; Herpesvirus 3, Human; Humans; Incidence; Intraocular Pressure; Male; Middle Aged; Prednisolone; Prognosis; Retrospective Studies; Simplexvirus; Uveitis, Anterior

Topics: Acyclovir; Aged; Antihypertensive Agents; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Prednisolone; Retinal Vasculitis; Timolol; Uveitis, Anterior; Vitreous Body

Scleromalacia usually appears following vasculitis in systemic rheumatoid diseases, especially as a late symptom of rheumatoid arthritis.. A 67-year-old woman was referred to our hospital for further evaluation with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago she had suffered from herpes zoster ophthalmicus-associated keratouveitis and trabeculitis in the same eye. Scleromalacia associated with varicella-zoster virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of the eye was completed and a systemic disease had been ruled out. One week after beginning systemic application of acyclovir (5 x 800 mg daily) and prednisolone (30 mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to appear in the atrophic scleral area.. Although scleral atrophy mostly appears as a late sign of systemic rheumatoid diseases, it might also develop secondary to infectious diseases. Scleromalacia associated with varicella-zoster virus has been previously described only in a few cases. Scleromalacia is a vision-threatening complication of zoster ophthalmicus which responds well to combination therapy with systemic antiviral and anti-inflammatory agents.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Aged; Anti-Inflammatory Agents; Antiviral Agents; Atrophy; Drug Therapy, Combination; Eye Hemorrhage; Female; Fibrosis; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Long-Term Care; Ophthalmoscopy; Prednisolone; Recurrence; Sclera; Scleral Diseases; Uveitis, Anterior

Acute retinal necrosis (ARN) is a severe ocular syndrome consisting of a moderate-to-severe anterior uveitis, vasculitis, and vaso-occlusive retinal necrosis. It can occur in healthy individuals at any age, but reports of this condition in children are rare.

Topics: Acyclovir; Antiviral Agents; Child; Eye Diseases; Female; Functional Laterality; Humans; Retinal Hemorrhage; Retinal Necrosis Syndrome, Acute; Uveitis, Anterior; Uveitis, Posterior; Vitreous Body

To report recurrent herpetic keratouveitis following YAG laser peripheral iridotomy.. Case report.. A 64-year-old woman with a history of dendritic keratitis underwent Nd:YAG laser peripheral iridotomy and developed geographic epithelial keratitis with stromal keratouveitis. Culture of a corneal swab grew herpes simplex virus type I. Keratouveitis subsided with acyclovir and corticosteroid therapy.. Recurrent herpetic keratouveitis may be induced by YAG laser iridotomy.

Topics: Acyclovir; Antiviral Agents; Betamethasone; Cornea; Drug Therapy, Combination; Female; Glucocorticoids; Herpesvirus 1, Human; Humans; Iridectomy; Keratitis, Herpetic; Laser Therapy; Middle Aged; Recurrence; Uveitis, Anterior

The purpose of this study was to examine the importance of considering the differential diagnosis for patients with sectorial keratitis and uveitis by case summary and literature review.. A retrospective review of patients with sectorial keratitis and uveitis seen at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary and a summary of the diagnoses of cases with similar ocular findings that have been reported in the literature.. Data on six patients with sectorial keratitis and uveitis were reviewed. Four patients were female and two were male, ages 21-50 years. All were eventually diagnosed with herpes simplex viral stromal sectorial keratitis. The corneal infiltrates were most common in the superior corneal quadrants, located in the posterior corneal layers. Anterior non-granulomatous uveitis was present in all cases. One case had bilateral ocular involvement. Five of the six patients responded to topical steroids and antiviral treatment. Immunomodulation with methotrexate, cyclosporine, and systemic prednisone was required in one patient. Glaucoma was a complication in six of the seven eyes. Five patients developed corneal scarring, localized in the anterior and mid-stroma.. The differential diagnosis of sectorial keratitis and uveitis is limited. The entities included in the differential are diverse; some of them threaten not only vision but also life. It is important for the ophthalmologist to be familiar with these entities, in order to pursue pertinent diagnostic investigations and arrive at an accurate diagnosis and institute appropriate management.

Topics: Acyclovir; Administration, Topical; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Stroma; Diagnosis, Differential; Female; Glucocorticoids; Humans; Keratitis, Herpetic; Male; Middle Aged; Prednisolone; Retrospective Studies; Uveitis, Anterior; Visual Acuity

To report a case of herpes zoster virus sclerokeratitis with anterior uveitis following vaccination with live attenuated varicella vaccine (Oka strain).. Case report.. The case records of the patient were reviewed retrospectively. Pertinent literature citations were identified using MEDLINE.. A 9-year-old boy presented with herpes zoster ophthalmicus 3 years following vaccination with live attenuated varicella vaccine (Oka strain). Examination of the affected eye revealed a moderate follicular response on the palpebral conjunctiva, decreased corneal sensation, mildly elevated intraocular pressure, diffuse anterior scleritis with marginal keratitis, and a moderately severe anterior uveitis. Amplified DNA from fluid taken from the base of a cutaneous vesicle produced wild-type varicella zoster virus (VZV) DNA, not Oka strain.. Herpes zoster virus infection needs to be considered in all patients who present with scleritis, keratitis, or anterior uveitis, regardless of their varicella vaccination status.

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child; Cyclopentolate; DNA, Viral; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis; Male; Prednisolone; Scleritis; Trigeminal Nerve Diseases; Uveitis, Anterior; Vaccination

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

Topics: Acyclovir; Adolescent; Adult; Aged; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Recurrence; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Uveitis, Anterior

To describe presumed activation of herpetic keratouveitis after argon laser peripheral iridotomy.. Case report.. A 68-year-old man developed chronic, unilateral, anterior uveitis associated with decreased corneal sensation, focal keratitis, and increased intraocular pressure after argon laser peripheral iridotomy. Treatment with oral acyclovir and discontinuation of topical latanoprost resulted in prompt and continued control of both the intraocular inflammation and pressure.. Herpetic keratouveitis may occur after argon laser iridotomy, and it should be considered when postoperative inflammation persists despite appropriate use of topical corticosteroids, particularly in patients with a history of herpetic eye disease.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Glaucoma; Herpesvirus 1, Human; Humans; Intraocular Pressure; Iris; Keratitis, Herpetic; Laser Therapy; Latanoprost; Male; Prostaglandins F, Synthetic; Uveitis, Anterior; Virus Activation

To report uveitis secondary to ocular penetration of caterpillar hairs (setae).. Case report. A documented attack of acute anterior uveitis was caused by initially overlooked penetration of caterpillar setae.. A 66-year-old man presenting with unilateral hypertensive keratouveitis was treated with antiherpes simplex medication (along with local anti-inflammatory and cycloplegic agents) after anterior chamber paracentesis and serologic testing. Laboratory testing was negative. Resolution occurred after 5 days, and corneal clearing showed a predescemetic caterpillar seta.. Patient history taken in an anterior uveitis setting should include gardening habits and searching for possible exposure to insects or arachnids.

Topics: Acute Disease; Acyclovir; Aged; Animals; Cornea; Corneal Injuries; Dexamethasone; Drug Therapy, Combination; Eye Foreign Bodies; Eye Injuries, Penetrating; Gentamicins; Hair; Humans; Lepidoptera; Uveitis, Anterior

To report a case of uveitis associated with the live attenuated varicella virus vaccine (Varivax; Merck & Co, Inc, West Point, Pennsylvania) in a young, otherwise healthy girl.. The time of onset of uveitis in relation to vaccination and the number and the pattern of distribution of vesicles were noted. The patient received oral acyclovir and topical steroids and cycloplegic drops.. The uveitis and vesicular rash improved significantly after 7 days of treatment. A literature review and communications with the drug's manufacturer disclosed no identifiable previous cases of uveitis associated with Varivax.. Uveitis should be recognized as a possible adverse side effect of the varicella vaccine.

Topics: Acyclovir; Adolescent; Anterior Eye Segment; Chickenpox Vaccine; Drug Therapy, Combination; Female; Humans; Intraocular Pressure; Prednisolone; Uveitis, Anterior; 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

The role of oral acyclovir (ACV) in the management of immunocompetent patients with herpes zoster ophthalmicus remains controversial. We have performed a retrospective, comparative, case-control study of cases seen in the Zoster Clinic at Moorfields Eye Hospital over the last 5 years. A standard proforma was used during this period to collect data on the rash, ocular involvement and treatment. There were 419 immunocompetent patients of whom 77 were treated with oral ACV prior to attending the clinic. We compared these with paired controls matched for age, sex and severity of rash. No difference in the rate of ocular complications between treated and untreated patients could be detected. This suggests that oral ACV as currently prescribed has little or no preventive effect on the ocular complications of ophthalmic zoster.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Aged, 80 and over; Case-Control Studies; Corneal Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Retrospective Studies; Scleritis; Treatment Outcome; Uveitis, Anterior

In a prospective open trial 40 patients suffering from acute herpes zoster ophthalmicus were treated with systemic acyclovir. An additional 10 patients were treated by topical acyclovir alone and dexamethasone eye-drops were administered to 5 of them to suppress ocular inflammation. In the topical treatment group the period of new skin lesion formation and progression of ocular inflammatory signs were significantly prolonged. Therapy with systemic acyclovir however resulted in a quick and complete resolution of ocular inflammation in all patients. Chronic ocular inflammation developed in 4 out of 10 patients treated with topical acyclovir. We consider chronic ocular zoster as a distinct clinical entity, possibly expressing a failing local immune response against VZV.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Bromodeoxyuridine; Chronic Disease; Conjunctivitis; Dexamethasone; Drug Administration Routes; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Male; Middle Aged; Prospective Studies; Scleritis; Skin Diseases; Uveitis, Anterior

The Laser Flare Cell Meter (LFCM, Kowa FC-1000), an instrument measuring aqueous flare and cells in a quantitative, objective and non-invasive way, has been mainly used so far to measure inflammation in clinical and experimental research. In the light of some illustrative examples, its practical clinical usefulness is presented; the LFCM was found to be specially helpful in 3 types of situations. 1. In acute anterior uveitis (AAU) patients, precise LFCM monitoring of inflammation made it possible to avoid excessive corticosteroid therapy, mainly by more rapid and controlled tapering at the end of an inflammatory episode, so possibly minimizing steroid side effects in a group of patients prone to numerous uveitis recurrences. In a steroid-responder patient it allowed successful treatment of a flare-up of AAU with a combination of systemic and topical diclofenac (Voltaren), a potent nonsteroidal antiinflammatory drug. 2. LFCM monitoring of inflammation in patients undergoing laser treatments allowed optimal adjustment of antiinflammatory therapy. Diclofenac drops (Voltarene Ophta), were sufficient to treat inflammation in all patients, undergoing Nd-YAG laser posterior capsulotomy or Argon laser trabeculoplasty. 3. In patients with acyclovir treated herpes simplex or herpes zoster uveitis corticosteroid treatment should be avoided whenever possible, because of the tendency to develop steroid dependency. LFCM monitoring of this group of patients gave a precise evolutionary pattern of inflammation and permitted to avoid steroid treatment in many patients.

Topics: Acyclovir; Administration, Oral; Anterior Chamber; Dexamethasone; Diclofenac; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Male; Middle Aged; Ophthalmic Solutions; Ophthalmoscopes; Uveitis, Anterior

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

The incidence and severity of herpes zoster ophthalmicus have increased because of the growing number of immunocompromised patients. Uveitis and keratitis are the most common inflammatory complications. Corneal exposure from scarring and contraction of the upper lid may require reconstructive plastic surgery. Preliminary studies of oral acyclovir, specifically targeted at preventing ocular complications, are encouraging.

Topics: Acyclovir; Antiviral Agents; Conjunctivitis, Viral; Eyelid Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Immune Tolerance; Keratitis; Male; Orbital Diseases; Retinal Diseases; United States; Uveitis, Anterior

Topics: Acyclovir; Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Female; Humans; Keratitis, Dendritic; Male; Middle Aged; Rabbits; Simplexvirus; Uveitis, Anterior

Topics: Acyclovir; Female; Humans; Keratitis, Dendritic; Male; Thymidine; Trifluridine; Uveitis, Anterior

The clinical value of five synthetic antiherpetic nucleosides is discussed: iododeoxyuridine (IDU), adenine-arabinoside (Ara-A), trifluorothymidine (TFT), acyclovir (ACV), and bromovinyldeoxyuridine (BVDU). Depending on the type of herpes simplex virus eye disease, either TFT or ACV are currently the drugs of choice. For BVDU, further controlled studies have to be awaited. For the special situation of superficial herpetic keratitis (dendritic keratitis), a combination therapy with either TFT or ACV plus interferon has proven to be significantly better than a monotherapy with only nucleosides.

Topics: Acyclovir; Antiviral Agents; Humans; Idoxuridine; Inflammation; Keratitis, Dendritic; Nucleosides; Trabecular Meshwork; Uveitis, Anterior; Vidarabine

Twenty patients with presumptive herpetic iridocyclitis without active corneal inflammation received either topical idoxuridine 0.5% or acyclovir 3% ointment. The uveitis of all ten patients treated with acyclovir resolved within one to eight weeks. Four of ten patients treated with idoxuridine worsened but subsequently responded to topical prednisolone 0.3%. The pathogenesis of herpetic iridocyclitis is discussed with a literature review.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Female; Guanine; Humans; Idoxuridine; Intraocular Pressure; Keratitis, Dendritic; Male; Middle Aged; Prednisolone; Uveitis, Anterior