brivudine and Corneal-Diseases

Prolonged topical trifluridine treatment of herpes simplex keratitis in three elderly patients produced slightly raised dysplastic corneal epithelial lesions. The involved epithelium had a ground-glass appearance and exhibited opaque cells, edema, and spindle-shaped surface cells. Histopathology demonstrated severe cellular atypism, loss of cell polarity, dyskeratosis, parakeratosis, and a few mitotic figures. The pathological change was apparently intraepithelial. After scraping, the edema and opaque cells in the regenerated epithelium gradually disappeared in 3-4 months on cessation of trifluridine therapy. In one patient recurrence of dendritic keratitis, 5 weeks after scraping, was treated by topical bromovinyldeoxyuridine eye drops. Since severe epithelial dysplasia may represent a precancerous condition, prolonged use of trifluridine should be avoided.

Topics: Age Factors; Aged; Antiviral Agents; Bromodeoxyuridine; Cornea; Corneal Diseases; Epithelium; Humans; Keratitis, Dendritic; Male; Microscopy, Phase-Contrast; Thymidine; Trifluridine

Two compounds, bromovinyldeoxyuridine ([E]-5-[2-bromovinyl]-2'-deoxyuridine) and trifluridine (5-trifluoromethyl-2' deoxyuridine) were compared for their efficacy in the topical treatment of experimental stroma herpetic keratitis produced by the injection of live herpes simplex virus, type 1, into the corneal stroma of rabbits. The trifluridine was used as 1% eyedrops, whereas bromovinyldeoxyuridine was used as either 0.1% or 0.5% eyedrops. All three treatment regimens caused a substantial healing of stroma disease in comparison with placebo treatment. The bromovinyldeoxyuridine (whether used as 0.1% or 0.5%) proved superior to 1% trifluridine eyedrops when the treatment was started one day after virus inoculation. However, bromovinyldeoxyuridine and trifluridine were equally effective if the treatment was started seven days after infection. The 0.5% bromovinyldeoxyuridine eyedrops seemed to be more effective in controlling the complicating severe iritis and secondary glaucoma than either 0.1% bromovinyldeoxyuridine or 1% trifluridine. No toxic effects were observed with bromovinyldeoxyuridine in any eye, whereas 1% trifluridine produced punctate epitheliopathy in some eyes.

Topics: Animals; Antiviral Agents; Bromodeoxyuridine; Corneal Diseases; Disease Models, Animal; Drug Administration Schedule; Keratitis, Dendritic; Ophthalmic Solutions; Rabbits; Thymidine; Trifluridine