acyclovir and Uveitis

There are still many research challenges and unanswered questions in relation to Epstein-Barr virus-associated uveitis. These include the presence of Epstein-Barr virus (EBV) DNA in asymptomatic patients, its pathogenicity in the uveitis eye, and the role of antiviral therapy for EBV-associated intraocular inflammation.. This was a retrospective review of prospectively collected data from the Ophthalmology Department, Rajavithi Hospital between 2015 and 2020. A qualitative assay using multiplex real-time PCR was performed to detect pathogen genes from specimens obtained from a total of 344 patients. The main outcome measure was treatment success defined by clinical improvement and absence of viral DNA confirmed by PCR.. Of the 35 cases, 24 with complete data were enrolled in the study, including 22 with post-treatment PCR results. Sixty-seven percent were HIV-infected, and other plausible causes or coinfection with other pathogens were found in 75% of patients. Cytomegalovirus (38%) was the most common co-infecting pathogen. The most commonly employed regimen was a combination of systemic acyclovir and intravitreal ganciclovir injection (58%). Of the 22 cases who had post-treatment PCR results, absence of detection of the virus by PCR in the intraocular fluid after treatment was demonstrated in 73% of patients.. Patients with EBV infection can be simultaneously co-infected with other pathogens. Systemic acyclovir and ganciclovir achieved clinical improvement in most cases, and EBV infection was cured in the majority of patients.

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Epstein-Barr Virus Infections; Ganciclovir; Herpesvirus 4, Human; Humans; Uveitis

Herpes zoster ophthalmicus occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve. Herpes zoster ophthalmicus represents up to one fourth of all cases of herpes zoster. Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed according to the affected dermatome. A minority of patients may also develop conjunctivitis, keratitis, uveitis, and ocular cranial-nerve palsies. Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain. Antiviral medications such as acyclovir, valacyclovir, and famcidovir remain the mainstay of therapy and are most effective in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of herpes zoster ophthalmicus. with referral to an ophthalmologist when ophthalmic involvement is present, are critical in limiting visual morbidity.

Topics: Acyclovir; Antiviral Agents; Blepharitis; Corneal Diseases; Herpes Zoster Ophthalmicus; Humans; Uveitis

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

Herpes zoster is a commonly encountered infectious disease primarily affecting the elderly and immunosuppressed. The natural history and complications of the disease and the principles of management are often not appreciated by clinicians in a variety of disciplines who may see the patient during the acute phase. Recent literature has furthered our understanding of the virology of herpes zoster and the roles of corticosteroid and antiviral therapy. We review the clinical features, diagnostic principles, and management controversies of herpes zoster.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Child; Diagnosis, Differential; Facial Paralysis; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesviridae; Herpesvirus 3, Human; Humans; Immunity, Cellular; Interferons; Keratitis; Middle Aged; Neuralgia; Uveitis; Vidarabine

To compare the efficacy and safety of valaciclovir and acyclovir in immunocompetent patients with herpes zoster ophthalmicus.. A multicenter, randomized, double-masked study.. One hundred ten immunocompetent patients with herpes zoster ophthalmicus diagnosed within 72 hours of skin eruption were treated; 56 were allocated to the valaciclovir group and 54 to the acyclovir group.. Patients randomized to the valaciclovir group received two 500-mg tablets of valaciclovir three times daily and one tablet of placebo twice daily. Patients in the acyclovir group received one 800-mg tablet of acyclovir five times daily and one tablet of placebo three times daily for 7 days.. Main outcome measures included the frequency, severity, and duration of ocular complications, patient reports of zoster-associated pain, and the outcome of skin lesions. Tolerance was also assessed on the incidence and types of adverse effects and changes in laboratory parameters. The analysis was mainly descriptive and performed on an intent-to-treat basis.. Ocular complications of herpes zoster ophthalmicus were similar in the valaciclovir and acyclovir treatment groups. The main complications were conjunctivitis (54% and 52%, respectively), superficial keratitis (39% and 48%, respectively for punctate keratitis; 11% in each group for dendritic keratitis), stromal keratitis (13% in each group), and uveitis (13% and 17%, respectively). The long-term outcomes of these ocular complications were favorable and similar in both treatment groups. Pain duration and severity and outcome of skin lesions were similar between groups. Most patients reported prodromal pain. After 1 month, 25% of patients in the valaciclovir group and 31% in the acyclovir group still reported pain. The percentage of patients experiencing postherpetic neuralgia decreased during follow-up. The tolerance to acyclovir and valaciclovir was comparable and considered good. The most frequent adverse events were vomiting and edema of the eyelids or face (3%-5%). Three serious adverse events not linked to the study drugs occurred.. Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain. Tolerability of the two drugs is similar, but the dosing schedule of valaciclovir is simpler.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Conjunctivitis, Viral; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Keratitis; Male; Middle Aged; Pain; Safety; Tablets; Uveitis; Valacyclovir; Valine

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

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

Herpes stromal disease is due to direct damage as a result of viral replication, virally induced immune mechanisms, or a combination of the two. Viral replication may have a major initiating role in the production of herpes simplex and herpes zoster induced stromal disease, and steroids may initially be harmful in their treatment. On topical antiviral drugs alone, in patients who never previously had had topical steroids, 14 of 15 cases of herpes simplex induced disciform keratitis responded favourably in an average of 44 days of treatment. This compared with one out of 14 responding if steroids had previously been used, 13 of 14 requiring topical steroids and an average 112 days' treatment. In herpes zoster stromal disease cases 78% had epithelial involvement, 54 of 57 responded to topical antivirals alone without the use of steroids, 2% recurred, and treatment averaged a total of 62 days. If steroids were used alone or in combination with antivirals, there was a 50% recurrence rate and 200 day total treatment duration.

Topics: Acyclovir; Administration, Topical; Clinical Trials as Topic; Dexamethasone; Double-Blind Method; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Recurrence; Uveitis; Vidarabine; Virus Replication

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

Topical acyclovir has been compared with topical steroids in a coded controlled trial of the treatment of keratouveitis caused by herpes zoster in 40 patients. Topical acyclovir was significantly superior to topical steroids in terms of treatment duration (75 days to 280 days), with no recurrences after the patients were weaned off treatment; there was a 63% recurrence rate in the steroid group. Corneal epithelial disease resolved significantly quicker in the acyclovir treated group. If recurrences occurred in the steroid group, other parts of the eye not initially affected were also involved. Treatment of such recurrences was more difficult than treatment of the initial attack.

Topics: Acyclovir; Administration, Topical; Aged; Betamethasone; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis; Male; Recurrence; Uveitis

The effect of acyclovir on the skin rash and herpes zoster keratouveitis has been studied. It has been shown to have a significant effect on both disease processes, and to be superior to topical steroids in the treatment of herpes zoster keratouveitis. Steroids have been found to have an adverse effect with prolonged treatment and frequent recurrences.

Topics: Acyclovir; Administration, Topical; Betamethasone; Clinical Trials as Topic; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Keratitis; Male; Recurrence; Retrospective Studies; Skin Diseases, Infectious; Uveitis

Acyclovir has veen shown to have potent antiviral activity against both herpes simplex and herpes zoster viruses, especially the former, with low cellular toxicity, preferentially affecting virally infective cells by inhibiting viral DNA synthesis [1,2]. In experimental herpes simplex corneal infection, acyclovir has been found to be effective [3,4] and in early clinical trials it has been found to be at least as good as idoxuridine [5-7]. Acyclovir has also been found to have antiviral activity against the herpes zoster virus in tissue culture [1] and to affect favorably the course of the disease in immunosuppressed patients [8]. This paper describes the use of acyclovir in patients with either herpes simplex or herpes zoster ocular infections. Topical acyclovir has been compared with adenine arabinoside in the treatment of herpes simplex corneal ulceration in a coded clinical trial. The use of acyclovir will also be described in patients with complicated herpes simplex eye disease. Our initial results with topical acyclovir in herpes zoster keratouveitis are also described.

Topics: Acyclovir; Antiviral Agents; Drug Evaluation; Drug Therapy, Combination; Female; Guanine; Herpes Zoster; Humans; Keratitis, Dendritic; Male; Steroids; Uveitis

Acute Retinal Necrosis (ARN) is a potentially devastating form of Uveitis. Antivirals are the mainstay treatment for this syndrome. In this letter, we question the current oral Valacyclovir dosage, based on the experience we had with a recent unresponsive ARN case.

Topics: Acyclovir; Antiviral Agents; Humans; Retinal Necrosis Syndrome, Acute; Uveitis; Valacyclovir

To investigate the prevalence of ocular manifestations and visual outcomes in patients with herpes zoster ophthalmicus (HZO).. Consecutive cases diagnosed with HZO who attended 2 hospitals between July 1, 2011, and June 30, 2015, were retrospectively reviewed. Patient demographics, clinical presentations, and management were reviewed. The logistic regression model was used to estimate the odds ratio of visual loss with ocular manifestations.. A total of 259 patients were included. Of these, 110 (42.5%) patients were <60 years old and 149 patients (57.5%) were ≥60 years old. None of the patients had received zoster vaccination before presentation. Ocular manifestations were present in 170 (65.6%) patients with no difference between both age groups (P = 0.101). Conjunctivitis was the most common ocular manifestation, followed by anterior uveitis and keratitis. After resolution of HZO, 58.7% of patients had a visual acuity of 6/12 or worse. Epithelial keratitis and stromal keratitis were independent risk factors for visual loss after resolution of HZO (P = 0.003 and P = 0.004, respectively). The corresponding odds ratio was 6.59 [95% confidence interval (CI): 1.87-23.19] and 7.55 (95% CI: 1.88-30.30), respectively. The number of ocular manifestations was also associated with an increased risk of visual loss with an odds ratio of 1.49 (95% CI: 1.01-2.20; P = 0.043).. A substantial proportion of patients with HZO were <60 years old in this study. The absence of zoster vaccination across the study cohort was noteworthy. Keratitis was the main reason for poor visual outcome in these patients.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Conjunctivitis, Viral; Famciclovir; Female; Herpes Zoster Ophthalmicus; Hong Kong; Humans; Keratitis; Male; Middle Aged; Prevalence; Retrospective Studies; Uveitis; Vision Disorders; Visual Acuity; Young Adult

Topics: Acyclovir; Antihypertensive Agents; Antiviral Agents; Aqueous Humor; Eye Infections, Viral; Herpes Simplex; Herpesvirus 1, Human; Humans; Intraocular Pressure; Lens Implantation, Intraocular; Male; Middle Aged; Ocular Hypertension; Phacoemulsification; Polymerase Chain Reaction; Uveitis; Virus Activation

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

Acyclovir (ACV) is the antiviral drug of choice to treat patients with herpes simplex virus type 1 (HSV-1) uveitis. The prevalence of intra-ocular ACV-resistant (ACV(R)) HSV-1 in herpetic uveitis is unknown and may have clinical consequences. In addition to its predictive value on ACV susceptibility, the polymorphic HSV-1 thymidine kinase (TK) gene facilitates differentiation between HSV-1 strains.. The objective of this study was to determine the genetic composition and ACV susceptibility of the causative virus in intra-ocular fluid samples (IOF) of HSV-1 uveitis patients.. The intra-ocular HSV-1 pool from 11 HSV-1 uveitis patients was determined by sequencing IOF-derived viral TK genes. The ACV susceptibility profile of the cloned intra-ocular TK variants was defined by mass spectrometry. In addition, the ganciclovir (GCV) susceptibility of the ACV(R) HSV-1 TK variants was defined.. Intra-ocular fluid samples of HSV-1 uveitis patients contain HSV-1 quasispecies, principally consisting of one major and multiple genetically related minor patient-specific TK variants. Four of 10 patients analyzed had an intra-ocular ACV(R) HSV-1 of which 3 were cross-resistant to GCV. The ACV(R) profile of intra-ocular HSV-1 did not correlate with symptomatic ACV treatment.. Affected eyes of HSV-1 uveitis patients are commonly infected with a patient-specific HSV-1 quasispecies, including one major and multiple genetically related minor variants. A relatively high prevalence of intra-ocular ACV(R) HSV-1, mainly ACV/GCV cross-resistant viruses, was detected in HSV-1 uveitis patients.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Resistance, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Sequence Data; Sequence Analysis, DNA; Thymidine Kinase; Uveitis

Herpes stromal keratitis is a serious condition and the most frequent cause of unilateral blindness. The real-time PCR is an accurate and fast diagnostic method for an analysis of infectious agents causing keratitis and keratouveitis. The aim of the study was to assess the relationship between clinical symptoms, treatment efficacy monitoring and viral quantity in corneal swabs determined by quantitative real-time PCR method. The real-time PCR method was used as well for the detection of other viral eye pathogens.. A total of 212 patients (136 men and 76 women) suspect of having herpes simplex virus (HSV) keratitis or keratouveitis were included in the study. The detection and quantitative analysis of the viral DNA were performed using the EliGene HSV1 RT kit, and the result was correlated with the clinical picture of the disease. The patients were routinely treated with acyclovir applied locally or, alternatively, in systemic administration. In a case of acyclovir treatment resistant keratitis, the patients were treated with local ganciclovir (Virgan gel ophth 0.15%).. A total of 636 analyses of the viral DNA were performed; 85 patients were positive for HSV1 (198 detected). There were 16 acyclovir resistant cases of keratitis (14%).. The real-time PCR appears as a fast and accurate method for an exact identification of the viral DNA in patients with herpes stromal keratitis. The introduction of the quantification is important for the treatment evaluation and for the specification of a so-called acyclovir resistant keratitis. A long-term systemic administration in maintenance doses may lead to the resistance and repeated, frequent relapses of the disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Child, Preschool; DNA, Viral; Female; Ganciclovir; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Male; Middle Aged; Real-Time Polymerase Chain Reaction; Uveitis; Young Adult

To report a unique presentation of 3rd and 6th cranial nerve palsies with nodular scleritis and nummular keratouveitis following an attack of herpes zoster ophthalmicus (HZO).. Case report.. A 56-year-old woman with a 1-month history of HZO presented with drooping of the right upper eyelid, diplopia, and pain around the right eye. She was noted to have right 3rd and 6th cranial nerve palsies. She developed nodular scleritis and nummular keratouveitis at 2 and 4 months follow-up, respectively, which were treated with antivirals and steroids. At 10 months follow-up, although the diplopia in right lateral gaze persisted, there was no recurrence of ocular inflammation with complete recovery of ptosis.. A unique presentation of multiple cranial nerve palsies with nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of HZO is highlighted in this report.

Topics: 2-Aminopurine; Abducens Nerve Diseases; Acyclovir; Antiviral Agents; Diplopia; Drug Therapy, Combination; Famciclovir; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Oculomotor Nerve Diseases; Prednisolone; Scleritis; Treatment Outcome; Uveitis

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

The purpose of the study is to investigate whether analysis of specific antibody synthesis can aid the diagnosis of herpes keratitis.. Aqueous humor was collected from 39 patients with presumed recurrent herpes keratitis, including 23 consulting for keratitis and 16 patients scheduled for penetrating keratoplasty. Local antibody production was ascertained by analysis of paired aqueous humor/serum samples, using a modified micro-ELISA technique.. Local production of antibodies was found in 32 patients (82%): anti-herpes simplex virus (HSV) antibodies in 26 (67%) and anti-varicella zoster virus (VZV) antibodies in 11 (28%). Twenty of 23 patients with active keratitis (87%), and 12 of 16 undergoing keratoplasty (75%), tested positive. Five patients had local production of both anti-HSV and anti-VZV antibodies, whereas seven patients tested negative. Local antibody production was significantly associated with intraocular inflammation (P<0.05), corneal neovascularisation (P<0.05), and positive response to anti-viral treatment (P<0.05). No complications were encountered in sampling aqueous humor.. Assessment of local anti-HSV and -VZV antibody production is a safe and reliable diagnostic procedure for recurrent herpes keratitis. It might be particularly helpful in patients presenting with intraocular inflammation and neovascularisation since it discriminates between herpes and non-herpes pathologies and may therefore be useful for preventive and therapeutic strategies.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Corneal Neovascularization; Enzyme-Linked Immunosorbent Assay; Female; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Recurrence; Risk Factors; Uveitis

To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV).. Retrospective comparative study.. Forty patients with HSV uveitis and 24 patients with VZV uveitis.. A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically.. Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed.. Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations.. This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups.

Topics: Acyclovir; Antiviral Agents; Cataract; Female; Glaucoma; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Recurrence; Retinal Diseases; Retrospective Studies; Uveitis; Visual Acuity

To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.. We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.. We identified 26 HIV-infected patients (50 involved eyes) with this syndrome. Median CD4+ T-lymphocyte count at presentation was 272 per microl (range, 7 to 2,118 per microl). The most common presenting symptom was floaters. Median visual acuity of involved eyes at presentation was 20/20 (range, 20/15 to 20/100) and remained stable (median, 20/20; range, 20/15 to 20/70) after a median follow-up period of 9 months (range, 0 to 110 months). Typical retinal lesions were gray-white or yellow, irregular in shape, and less than 200 microm in greatest dimension. All were located in the midperiphery or anterior retina and enlarged slowly or remained static in size. Mild to moderate anterior chamber or vitreous humor inflammatory cells were present in 47 of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to zidovudine but not to acyclovir or ganciclovir. Anterior chamber and vitreous humor inflammatory reactions responded to topical or periocular injections of corticosteroid.. Uveitis with chronic multifocal retinal infiltrates is a distinct clinical entity of unknown cause that occurs in HIV-infected patients. Retinal lesions may respond to antiretroviral therapy. Visual prognosis is good.

Topics: Acyclovir; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Chronic Disease; Fundus Oculi; Ganciclovir; HIV Infections; Humans; Male; Middle Aged; Retinal Diseases; Syndrome; Uveitis; Visual Acuity; Zidovudine

Sixteen patients with relapsing or chronic HSV keratouveitis were treated during a new attack by acyclovir 15 mg/kg/day by the i.v. route for 5 days with local combination of acyclovir 3% ung. and steroids. In all 16 patients improvement of signs of keratouveitis occurred on the fourth day of therapy, in 10 patients with improvement of visual acuity. In 5 patients perforating keratoplasty was performed on account of turbidity of the cornea. The authors observed four relapses of the disease in the course of 12 months after termination of treatment.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Antiviral Agents; Chronic Disease; Female; Humans; Infusions, Intravenous; Keratitis, Herpetic; Male; Middle Aged; Recurrence; Uveitis

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

Seventeen patients with presumed chronic herpetic uveitis of all anatomic types underwent systemic treatment with oral and/or intravenous, acyclovir. The diagnosis of herpes had been established on data from serological tests of the aqueous humor. Results were judged according to corticodependance and visual acuity. Results were all the more positive as treatment was more prolonged and also correlated with the dose of acyclovir injected intravenously or taken orally every day. Follow-up ranged from 6 months to several years.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Dose-Response Relationship, Drug; Female; Humans; Injections, Intravenous; Keratitis, Herpetic; Male; Middle Aged; Time Factors; Uveitis

A case of acyclovir-resistant herpes simplex virus keratouveitis after penetrating keratoplasty is reported.. Resistance to acyclovir was evident clinically and was confirmed by in vitro susceptibility testing. The susceptibility of the herpes simplex isolates to acyclovir and foscarnet was determined by a dye uptake assay that measured cytopathic effect, and thymidine kinase activity was measured by a plaque autoradiography technique.. The viral isolate from postoperative day 22 was susceptible to acyclovir and foscarnet, and showed normal thymidine kinase activity. Isolates from postoperative days 29 and 32 (coinciding with deterioration in clinical appearance) were resistant to acyclovir, susceptible to foscarnet, and deficient in thymidine kinase activity.. Practitioners should be aware of the potential for the emergence of resistance in this setting; prophylaxis and rational alternate therapies are discussed.

Topics: Acyclovir; Administration, Oral; Animals; Drug Resistance, Microbial; Foscarnet; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Microbial Sensitivity Tests; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Simplexvirus; Uveitis; Vero Cells; Visual Acuity

Systemic acyclovir (ACV), a new potent anti-herpes drug, was shown to reduce effectively the morbidity in the acute phase of herpes zoster ophthalmicus (AHZO). Using high dose oral ACV (5 X 800 mg/day) our aim in this study was: (1) to compare disease profiles in the ACV-treated group and in a group of zoster patients having had no ACV, analysed retrospectively; (2) to establish if high-dose ACV was able to prevent severe long term complications of AHZO; and (3) to determine the present role of corticosteroids in AHZO. From 1984 to 1988, 48 patients with AHZO of less than 3 days' duration were included. All patients received at least 7 days of oral ACV (5 X 800 mg/d) associated with topical ACV. Steroids were not given unless severe uveitis occurred. Follow-up was 2 years in 43 patients and 1 year in all 48 patients. Main conclusions from our study are: 1. Ocular involvement occurred in 67% of ACV-treated cases, a rate comparable to our retrospective group (59%) and to the literature (71%). However the rate of severe long term complications was minimal (4%) when compared to our non-treated retrospective group (21%). 2. Steroid treatment was not necessary in any of the ACV-treated patients. 3. ACV was well tolerated and did not have to be discontinued in any of the patients. High dose ACV and avoidance of steroids seems to eliminate the severe complications of AHZO.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Child; Dose-Response Relationship, Drug; Drug Tolerance; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Uveitis

Acyclovir, an oral antiviral agent that inhibits viral DNA replication, was used to treat 27 patients (16 males, 11 females) (mean age, 50 years) with vision-threatening herpes simplex virus (HSV) infections. Twenty patients had active stromal keratitis or keratouveitis, four had controlled nonnecrotizing stromal keratitis but could not taper topical medications, and four eczema patients with previous HSV infections had intraocular surgery (1 of these patients also is included in the 20 with active stromal keratitis). All 20 patients with active stromal keratitis or keratouveitis improved on acyclovir, all four patients using acyclovir postoperatively were disease-free while on the drug, but only two of the four patients using acyclovir to assist tapering topical medications were successful. There has been only one recurrence during a cumulative 194 months while on acyclovir. Thirteen patients have remained on acyclovir, and three who stopped acyclovir had prompt recurrences. Acyclovir seems to be a promising adjunct antiviral agent for the treatment of recalcitrant epithelial, stromal, or uveal disease secondary to HSV.

Topics: Acyclovir; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Child; Cornea; Drug Therapy, Combination; Female; Herpes Simplex; Humans; Keratitis, Dendritic; Male; Middle Aged; Necrosis; Recurrence; Uveitis

Ocular involvement with acute Epstein-Barr virus infection is usually limited to a transient follicular conjunctivitis, although other lesions have been reported. Chronic Epstein-Barr virus infection has recently gained attention, but ocular manifestations have not been emphasized. We describe three patients with chronic infection with prominent ocular involvement. Bilateral uveitis was noted in all patients, ranging from an anterior uveitis that was responsive to steroids to a severe panuveitis with vitritis, cataract, optic disc swelling, and macular edema. In one patient, topical acyclovir ointment resulted in a substantial decrease in the inflammatory reaction when added to systemic acyclovir therapy. Another patient displayed a keratitis that resolved with topical steroid therapy. Cataract and vitreous surgery were also beneficial in the management of these patients.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Cataract; Cataract Extraction; Chronic Disease; Female; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Keratitis, Dendritic; Male; Uveitis

Topics: Acyclovir; Administration, Topical; Adult; Antigens, Viral; Drug Therapy, Combination; Endothelium; Female; Humans; Intraocular Pressure; Keratitis, Dendritic; Prednisolone; Simplexvirus; Timolol; Uveitis

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

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans; Steroids; Uveitis

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

2'-O-glycylacyclovir, a water-soluble ester derivative of acyclovir, has proved efficacious in the topical treatment of epithelial and stromal herpes simplex keratitis, and iritis therewith associated, when administered as a 1% eyedrop formulation to rabbits.

Topics: Acyclovir; Animals; Keratitis, Dendritic; Ophthalmic Solutions; Rabbits; Solubility; Uveitis

Topics: Acyclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Uveitis