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A Controlled Trial of Oral Acyclovir for the Prevention of Stromal Keratitis or Iritis in Patients With Herpes Simplex Virus Epithelial Keratitis: The Epithelial Keratitis Trial

A Controlled Trial of Oral Acyclovir for the Prevention of Stromal Keratitis or Iritis in... Abstract Objective: To evaluate the efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis caused by herpes simplex virus (HSV). Methods: 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. Results: 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). Conclusions: 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. References 1. National Institutes of Health. Workshop on the treatment and prevention of herpes simplex virus infections . J Infect Dis . 1973;127:117-119.Crossref 2. Liesegang TJ, Melton LJ, Daly PJ, llstrup DM. Epidemiology of ocular herpes simplex: incidence in Rochester, Minn, 1950 through 1982 . Arch Ophthalmol . 1989;107:1155-1159.Crossref 3. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management . Surv Ophthalmol . 1976;21:121-135.Crossref 4. Pepose JS. Herpes simplex keratitis: role of viral infection versus immune response . Surv Ophthalmol . 1991;35:345-352.Crossref 5. Liesegang TJ. Epidemiology of ocular herpes simplex: natural history in Rochester, Minn, 1950 through 1982 . Arch Ophthalmol . 1989;107:1160-1165.Crossref 6. Norn MS. Dendritic (herpetic) keratitis, I: incidence, seasonal variations, recurrence rate, visual impairment, therapy . Acta Ophthalmol . 1970;48:91-107.Crossref 7. McGill J, Williams H, McKinnon J, et al. Reassessment of idoxuridine therapy of herpetic keratitis . Trans Ophthalmol Soc U K . 1974;94:542-552. 8. McGill J, Holt-Wilson AD, McKinnon JR, et al. Some aspects of the clinical use of trifluorothymidine in the treatment of herpetic ulceration of the cornea . Trans Ophthalmol Soc U K . 1974;94:342-352. 9. Wilhelmus KR, Coster DJ, Donovan HC, et al. Prognostic indicators of herpetic keratitis: analysis of a five-year observation period after corneal ulceration . Arch Ophthalmol . 1981;99:1578-1582.Crossref 10. Herpetic Eye Disease Study Group. Manual of Operations, version date August 1, 1994. Available from the National Technical Information Service, Springfield, Va (accession No. PB97-112999). 11. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chem Rep . 1966;50:163-170. 12. Hung SO, Patterson A, Rees PJ. Pharmacokinetics of oral acyclovir (Zovirax) in the eye . Br J Ophthalmol . 1984;68:192-195.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

A Controlled Trial of Oral Acyclovir for the Prevention of Stromal Keratitis or Iritis in Patients With Herpes Simplex Virus Epithelial Keratitis: The Epithelial Keratitis Trial

Archives of Ophthalmology , Volume 115 (6) – Jun 1, 1997

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References (11)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150705001
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To evaluate the efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis caused by herpes simplex virus (HSV). Methods: 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. Results: 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). Conclusions: 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. References 1. National Institutes of Health. Workshop on the treatment and prevention of herpes simplex virus infections . J Infect Dis . 1973;127:117-119.Crossref 2. Liesegang TJ, Melton LJ, Daly PJ, llstrup DM. Epidemiology of ocular herpes simplex: incidence in Rochester, Minn, 1950 through 1982 . Arch Ophthalmol . 1989;107:1155-1159.Crossref 3. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management . Surv Ophthalmol . 1976;21:121-135.Crossref 4. Pepose JS. Herpes simplex keratitis: role of viral infection versus immune response . Surv Ophthalmol . 1991;35:345-352.Crossref 5. Liesegang TJ. Epidemiology of ocular herpes simplex: natural history in Rochester, Minn, 1950 through 1982 . Arch Ophthalmol . 1989;107:1160-1165.Crossref 6. Norn MS. Dendritic (herpetic) keratitis, I: incidence, seasonal variations, recurrence rate, visual impairment, therapy . Acta Ophthalmol . 1970;48:91-107.Crossref 7. McGill J, Williams H, McKinnon J, et al. Reassessment of idoxuridine therapy of herpetic keratitis . Trans Ophthalmol Soc U K . 1974;94:542-552. 8. McGill J, Holt-Wilson AD, McKinnon JR, et al. Some aspects of the clinical use of trifluorothymidine in the treatment of herpetic ulceration of the cornea . Trans Ophthalmol Soc U K . 1974;94:342-352. 9. Wilhelmus KR, Coster DJ, Donovan HC, et al. Prognostic indicators of herpetic keratitis: analysis of a five-year observation period after corneal ulceration . Arch Ophthalmol . 1981;99:1578-1582.Crossref 10. Herpetic Eye Disease Study Group. Manual of Operations, version date August 1, 1994. Available from the National Technical Information Service, Springfield, Va (accession No. PB97-112999). 11. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chem Rep . 1966;50:163-170. 12. Hung SO, Patterson A, Rees PJ. Pharmacokinetics of oral acyclovir (Zovirax) in the eye . Br J Ophthalmol . 1984;68:192-195.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 1997

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