Herpes simplex virus infections of the eye and their management with acyclovir
|
|
- Wilfrid Asher Preston
- 5 years ago
- Views:
Transcription
1 Journal of Antimicrobial Chemotherapy (1983) 12, Suppl. B, Herpes simplex virus infections of the eye and their management with acyclovir M. G. Falcon Eye Department, St Thomas' Hospital, London SEl TEH, England Hcrpetic kcratitis remains a prominent cause of recurrent or chronic and blinding corneal disease; areas of particular difficulty are indolent ulceration, herpetic keratouveitis, keratoplasty and problems associated with steroid therapy. Topical acyclovir has been widely demonstrated to be a safe and effective antiviral for ulcerative herpetic keratitis; furthermore its particular advantages of high efficacy, minimal toxicity and good ocular penetration, suggest that it should be the treatment of choice for patients within these other areas of particular difficulty. Introduction Herpes simplex keratitis remains one of the most important causes of blindness from corneal disease. This disease is usually produced by HSV I. There is a mass of experimental and clinical evidence indicating that the virus can remain latent in the Gasserian ganglion. For reasons that are still not clear, activation of latent virus occurs in some individuals which leads to clinical disease. This may be manifest as ulcerative (dendritic or amoeboid) keratitis which is the direct result of virus replication within the epithelium; there can also be visible signs of involvement deeper within the cornea or within the eye, producing a wide spectrum of clinical signs in the general category of keratouveitis. Such disease may be mediated by inflammatory (particularly type IV) mechanisms, or by viral replication, or by both, and it is here that the principal problems of herpetic keratitis occur. Simple epithelial disease, unless it becomes chronic, rarely produces significant loss of vision since the epithelium has good powers of regeneration, but delayed (indolent) ulceration may be very problematical; here toxicity of antiviral compounds often plays a primary role, whereas stromal disease, and secondary changes such as corneal anaesthesia and tear film disorders may also be implicated, and secondary bacterial or fungal infection may supervene, with disastrous consequences. Stromal disease, unaccompanied by ulceration, may also frequently lead to stromal opacification from scarring and vascularization. Furthermore, the ophthalmologists' attempts to maintain corneal transparency by reducing an inflammatory response in the stroma with topical steroids may encourage HSV replication; such steroid therapy must therefore be accompanied by antiviral therapy, which is not always completely effective, and which may need to continue for many weeks. A considerable proportion of patients with cornea! scarring from herpetic keratouveitis eventually undergo keratoplasty, following which there is a particular need for intensive topical immunosuppressive (steroid) therapy to prevent graft rejection; here again the effect of steroids in encouraging virus replication can cause considerable difficulties, which have hitherto been compounded by the toxic effects of antiviral therapy on the fragile epithelium of the graft /83/12B J02.00/ The British Journal of Antimicrobial Chemotherapy
2 40 M. G. Fakon The main problem areas of herpetic keratitis may thus be summarized as: latency and recurrence, for which there is as yet no practical therapy; indolent ulceration, a sequel to simple herpetic epithelial disease, where antiviral toxicity is often the principal factor; and steroid therapy (whether employed for stromal disease, or following keratoplasty) when any beneficial effect may be overweighed by the effect of encouraging virus replication, since antiviral therapy may not always be effective in controlling this potential complication. Undoubtedly there have been great advantages in the management of patients with herpetic eye disease since the introduction of idoxuridine (IDU) and more recently of adenine arabinoside (Ara A) and trifluorothymidine (F3T), but these drugs are to some extent limited by being toxic and having inadequate ocular penetration, and the problems described above still occur all too frequently. The introduction of acyclovir brings in a truly herpes virus-specific and non-toxic antiviral with good ocular penetration from topical (Poirier et al., 1982) or systemic routes, which has greatly increased the scope of therapy for this disease. The results of clinical and other investigations to assess its effect will now be reviewed. Ulcerative disease Clinical assessment of acyclovir The first clinical trial of topical acyclovir (ACV) in herpetic keratitis was carried out at Moorfields Eye Hospital in 1979 (Jones et al., 1979). It was based on experience of an earlier trial of interferon (Jones, Coster & Falcon, 1976), which was designed to demonstrate any effect from topical application of the substance in reducing early recurrences following a simple debridement. This had the advantage of requiring the smallest amount of the substance under assessment to produce a significant result. ACV was highly effective in this preliminary trial with the expectedly minimal toxicity. There shortly followed a number of clinical trials in epithelial disease in which ACV was compared with another standard antiviral; several of these were described at the previous Acyclovir Symposium (King & Galasso, 1982). Coster et al. (1980) compared ACV and IDU and found no significant difference in cure rates or healing rates, and the multicentre trial of McCulley et al. (1982) has reached the same conclusions. There was less punctate epitheliopathy in those patients treated with ACV. Collum, Benedict- Smith & Hillary (1980) in a similar comparative study found that ACV cured a higher proportion of patients than IDU, and led to more rapid healing; the trial of Colin et al. (1981) supported this conclusion. A recent paper by KJauber & Ottovay (1982) comparing ACV and IDU found a superior cure rate with ACV. There was moreover a suggestion that more patients with accompanying stromal disease healed if they were treated with ACV (7 in 8 patients) than if treated with IDU (4 in 10 patients). There have been some similar suggestions in other trials, although none has reached statistical significance. Several clinical trials have compared ACV with topical Ara A in patients with epithelial disease. Tormey, McGiU & Walker (1981) and McGill, Tormey & Walker (1981) found no statistically significant difference in healing rate, nor in the course of co-existing stromal disease. Young, Patterson & Ravenscrofl (1982) found a significant difference in the healing rate, in favour of ACV. Trifluorothymidine has been shown to be at least as effective as Ara A and superior to IDU, where the disease wasrelativelymild, as in dendritic ulcers (Coster et al., 1976). It was superior to Ara A where the disease was severe, as in amoeboid ulcers (Coster,
3 Herpes simplex Hms infections of tbe eye 41 Jones & McGiU, 1979). The clinical trial of F3T and ACV in patients with dendritic ulcers (La Lau et al., 1982) showed that both drugs were comparable in efficacy. If valid comparisons can be made across different trials, then this result is as anticipated, indicating that ACV and F3T have some superiority over IDU and Ara A. Two investigations have been carried out to assess the value of debridement in combination with ACV therapy for ulcerative herpetic keratitis. Wilhehnus, Coster & Jones (1981) found that combined debridement and ACV therapy led to a significantly faster healing rate with ACV alone. Jensen, Nissen & Jessen (1982) on the other hand, in a trial where nearly one-third of the patients had failed to respond first to other antiviral agents, found no difference between ACV and ACV plus debridement. Either treatment schedule appeared to be effective for metaherpetic ulceration. These trials of ACV therapy in patients with ulcerative herpetic keratitis have provided an impressive body of evidence that the drug is well tolerated, safe and effective, even when other antivirals have failed. ACV is at least as effective as the other antivirals used, and there have been suggestions (as yet lacking statistical confirmation) that there may be a benefit in certain types of herpetic stromal disease. Keratouveitis Clinical trials in stromal herpetic keratitis have been notoriously difficult to execute, because of the variable nature of the disease, to which therapy should be adjusted precisely. Nevertheless, Collum, Logan & Ravenscroft (1983) have recently published a trial in which 40 patients with disciform keratitis were treated either with ACV or with ACV and 001 % betamethasone. This important trial demonstrates two principle points: firstly, that 40% of the patients treated with ACV alone were healed (i.e. there was no clinical evidence of active disease) within 50 days; secondly, that all the patients treated with ACV and steroid were healed within 41 days. Although objective comparisons are limited by the absence of other clinical trials, and by the absence of clinical details about individual patients in this trial, the healing rates appear to be better than those generally experienced previously, both in the non-steroid group and in the steroid group: clinicians attempting to control disciform keratitis without steroid have failed in a high proportion of patients, and have eventually felt bound to use steroids because of intolerable symptoms, or because of signs indicating a risk of permanent damage to the eye such as endothelial decompensation or raised intraocular tension. The steroid group also fared particularly well: a 100% healing rate within 41 days in 20 patients with disciform keratitis is exceptional, and there were apparently no problems following withdrawal of steroid therapy. It is tempting to conclude that these good results are due to the presence within the cornea and anterior chamber of therapeutic levels of ACV: for whether or not disciform keratitis is partly mediated by viral replication, it is undoubtedly desirable that there should be an effective level of antiviral within the eye during steroid therapy. The failure of other antivirals to enter the eye may account for the apparent worsening of some cases of disciform keratitis on steroid therapy: the worsening clinical signs may have been brought about by viral replication encouraged by the steroid therapy under inadequate antiviral prophylaxis. Shimeld's demonstration (Shimeld et al., 1982) that there is virus in the cornea of herpetic patients even after 6 months of inactivity, indicates very nicely the dangers which could arise from unprotected steroid therapy. Wilhehnus, Falcon & Jones (1981) treated 20 patients who had presumed herpetic iridocyclitis either with ACV or with IDU. All those in the ACV group resolved within 8 weeks, whereas 4 out of the
4 42 M. G. Falcon 10 in the IDU group worsened and required steroid therapy. The numbers are small and the conclusions are thus uncertain. It is clear, however, that ACV should be the antiviral of choice in this condition (regardless of the precise pathogenesis) because of its good ocular penetration: the principles discussed in the context of stromal disease still hold. Keratoplasty Keratoplasty is the only feasible treatment for severe visual loss due to corneal scarring from herpetic keratitis, and it may also be used ocasionally for therapeutic purposes, where medical means of controlling active disease have failed. Although several surveys have demonstrated certain favourable prognostic factors and other unfavourable prognostic factors, it is generally agreed that the prognosis for keratoplasty in herpes is nevertheless uncertain, because of the possibilities of recurrence of ulcerative herpetic disease, or keratouveitis or rejection. As discussed earlier, a full regimen of topical steroid is essential postoperatively for prophylaxis against rejection. Opinions have varied hitherto concerning the routine use of antiviral prophylaxis: if used, it was associated with a high incidence of toxic epitheliopathy and even persistent ulceration; if not used, there was an increased risk of recurrence of viral replication. The availability of ACV has been welcomed by clinicians as a satisfactory solution to this dilemma. It can be used quite safely in the postoperative period without disturbing the epithelium of the graft: this will lead to a major improvement in the prospects for keratoplasty in herpetic patients. A question as yet unanswered, is - when should the antiviral therapy be curtailed, and - should it be reduced suddenly or gradually? It is possible that the latter course may lead to an increased incidence of ACV-resistant strains of HSV, just as these can be produced in vitro by exposure to the drug. Careful monitoring of patients receiving such a treatment regime should provide an answer. Conclusion Clinical studies to date have demonstrated that ACV is a safe and effective antiviral for therapy of ulcerative herpetic keratitis. There are indications that it may have some superiority over IDU, Ara A and F3T. The combination of good efficacy, minimal toxicity and good ocular penetration indicates that ACV should be the drug of choice in the problem areas of indolent herpetic ulceration, in stromal disease as antiviral cover for steroid therapy, and likewise in keratoplasty as antiviral prophylaxis for steroid therapy. It is anticipated that ACV will have a considerable impact in lessening these difficulties. Further clinical studies are underway which will assess these roles for ACV more precisely. Concern over the readiness with which HSV may become resistant to ACV is fortunately reduced by the fact that these resistant strains are of reduced virulence, in proportion to their failure to induce thymidine kinase (Gordon et al., 1983). References Colin, J., Tournoux, A., Chastel, C. & Renard, G. (1981). Superficial herpes simplex keratitis. Double-blind comparative trial of acyclovir and idoxuridine. La Nouvelle Prase Medicate 10, Collum, L. M. T., Benedict-Smith, A. & Hillary, I. B. (1980). Randomised double-blind trial of acyclovir and idoxuridine in dendritic corneal ulceration. British Journal of Ophthalmology 64,
5 Herpes simplex Tims infections of the eye 43 Colhun, L. M. T, Logan, P. & Ravenscroft, T. (1983). Acyclovir (Zovirax) in herpetic disciform keratitis. British Journal of Ophthalmology 67, Coster, D. J., Jones, B. R. & McGilL J. (1979). Treatment of amoeboid herpetic ulcers with adenine arabinoside or trifluorothymidine. British Journal of Ophthalmology 63, Coster, D. J., McKinnon, J. R., McGill, J., Jones, B. R. & Fraunfelder, F. T. (1976). Clinical evaluation of adenine arabinoside and trifluorothymidine in the treatment of corneal ulcers caused by herpes simplex virus. Journal of Infectious Disease 133, A Coster, D. J., Wilhelmus, K. R., Michaud, R. & Jones, B. R. (1980). A comparison of acyclovir and idoxuridine as treatment for ulcerative herpetic keratitis. British Journal of Ophthalmology 64, Gordon, Y. J., Armstrong, J. A., Brown, S. I. & Becker, Y. (1983). The role of herpes virus type I thymidine kinase in experimental ocular infections. American Journal of Ophthalmology 95, Jensen, K. B., Nissen, S. H. & Jessen, F. (1982). Acyclovir in the treatment of herpetic keratitis. Ada Ophthabnologica 60, Jones, B. R., Coster, D. J. & Falcon, M. G. (1976). Topical therapy of ulcerative herpetic keratitis with human interferon. Lancet fa, 128. Jones, B. R., Coster, D. J., Fison, P. N., Thompson, G. M., Cobo, L. M. & Falcon, M. G. (1979). Efficacy of acycloguanosine (Wellcome 248U) against herpes simplex corneal ulcers. Lancet i, 243^4. King, D. H. & Galasso, G. (1982). Proceedings of a Symposium on acyclovir. American Journal of Medicine 73, 1A. Klauber, A. & Ottovay, E. (1982). Acyclovir and idoxuridine treatment of herpes simplex keratitis - a double-blind clinical study. Acta Opthabnologica 60, La Lau, C, Oosterhuis, J. A., Versteeg, J., Van Rij, G., Renardel de Lavalette, J. G. C, Craandijk, A. & Lamers, W. P. M. A. (1982). Acyclovir and trifluorothymidine in herpetic keratitis: a multicentre trial. British Journal of Ophthalmology 66, McCulley, J. P., Binder, P. S., Kaufman, H. E., O'Day, D. M. & Poirier, R. H. (1982). A doubleblind, multicenter clinical trial of acyclovir vs idoxuridine for treatment of epithelial herpes simplex keratitis. Ophthalmology 89, McGill, J., Tormey, P. & Walker, C. B. (1981). Comparative trial of acyclovir and adenine arabinoside in the treatment of herpes simplex corneal ulcers. British Journal of Opthalmology 65, Poirier, R. H., Kingham, J. D., de Miranda, P. & Annel, M. (1982). Intraocular antiviral penetration. Archives of Opthalmology 100, Shimeld, C, Tullo, A. B., Easty, D. L. & Thomsitt, J. (1982). Isolation of herpes simplex virus from the cornea in chronic stromal keratitis. British Journal of Ophthalmology 66, Tormey, P., McGilL J. & Walker, C. (1981). Use of acyclovir in herpes simplex corneal ulcers. Transactions of the Opthalmological Society of the U.K. 101, 6-8. Wilhelmus, K. R., Coster, D. J.&Jones, B. R. (1981). Acyclovir and debridement in the treatment of ulcerative herpetic keratitis. American Journal of Opthalmology 91, Wilhelmus, K. R., Falcon, M. G. & Jones, B. R. (1981). Herpetic iridocylitis. International Ophthalmology 4, Young, B. J., Patterson, A. & Ravenscroft, T. (1982). A randomised double-blind clinical trial of acyclovir (Zovirax) and adenine arabinoside in herpes simplex corneal ulceration. British Journal of Ophthalmology 66,
Rational acyclovir therapy in herpetic eye disease
British Journal of Ophthalmology, 1987, 71, 102-106 Rational acyclovir therapy in herpetic eye disease M G FALCON From the Department of Ophthalmology, St Thomas's Hospital, London SEI 7EH SUMMARY Acyclovir
More informationGSK Clinical Study Register
In February 2013, GlaxoSmithKline (GSK) announced a commitment to further clinical transparency through the public disclosure of GSK Clinical Study Reports (CSRs) on the GSK Clinical Study Register. The
More informationIsolation of herpes simplex virus from the cornea in
British Journal of Ophthalmology, 1982, 66, 643-647 Isolation of herpes simplex virus from the cornea in chronic stromal keratitis C. SHIMELD, A. B. TULLO, D. L. EASTY, AND J. THOMSITT* From the Department
More informationCondition: Herpes Simplex Keratitis
Condition: Herpes Simplex Keratitis Description: Herpes simplex infection is very common but usually remains latent. When the virus is reactivated it travels along the trigeminal nerve to cause local infection
More informationHerpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry
Herpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry I have what?! How to break the news Meet the Herpes Quick virology
More informationOCULAR HERPES simplex virus
CLINICAL SCIENCES Oral Acyclovir After Penetrating Keratoplasty for Herpes Simplex Keratitis Fabiana P. Tambasco, MD; Elisabeth J. Cohen, MD; Lien H. Nguyen, MD; Christopher J. Rapuano, MD; Peter R. Laibson,
More informationSummary code for ocular herpes simplex
Brit. Y. Ophthal. (I975) 59, 539 ummary code for ocular herpes simplex JOHN McKINNON*, JAME McGILLt, AND BARRIE R. JONE From the Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields
More informationBalderson et al. BMC Ophthalmology (2015) 15:42 DOI /s
Balderson et al. BMC Ophthalmology (2015) 15:42 DOI 10.1186/s12886-015-0022-2 RESEARCH ARTICLE Open Access A systematic review and meta-analysis to compare the efficacy of acyclovir 3% ophthalmic ointment
More informationQ: (picture of typical dendrite) What is the differential diagnosis and describe this entity? How would you treat and why?
Q: (picture of typical dendrite) What is the differential diagnosis and describe this entity? How would you treat and why? Etiology/Risks: Critical symptoms: HSV is transmitted by direct contact of epidermis
More informationH erpes simplex virus infection of the
Herpes simplex keratitis An experimental study Samuel J. Kimura, Victor Diaz-Bonnet, and Masao Okumoto The incidence of complicated herpes simplex keratitis appears to have increased and the important
More informationCORNEAL CONDITIONS CORNEAL TRANSPLANTATION
GENERAL INFORMATION CORNEAL CONDITIONS CORNEAL TRANSPLANTATION WHAT ARE CORNEAL CONDITIONS? The cornea is the clear outer layer of the eye. Shaped like a dome, it helps to protect the eye from foreign
More informationBY N. N. SOODt AND V. J. MARMION- St. Paul's Eye Hospital, Liverpool
Brit. J. Ophthal. (1964) 48, 609. SUPERFICIAL HERPETIC KERATITIS TREATED WITH 5-IODO-2'-DEOXYURIDINE* BY N. N. SOODt AND V. J. MARMION- St. Paul's Eye Hospital, Liverpool THE results of treating herpetic
More information8/7/12. Anterior Seg Grand Rounds Case III. New Advances in the Management of Viral Eye Disease. Slit lamp exam: Sign: 68 y.o.
New Advances in the Management of Viral Eye Disease Anterior Seg Grand Rounds Case III 68 y.o. Caucasian female!! Dr.Paul Karpecki!! Corneal Services and Ocular Disease Research!! Koffler Vision Group
More informationKoppolu Sreedhar Reddy 1* and Venkata Prasanna DP 2
e - ISSN - 2349-8005 INTERNATIONAL JOURNAL OF ADVANCES IN CASE REPORTS Journal homepage: www.mcmed.us/journal/ijacr EFFICACY OF TOPICAL ACYCLOVIR IN TREATMENT OF HERPETIC KERATITIS Koppolu Sreedhar Reddy
More informationTrifluridine Ophthalmic Solution, 1% Sterile
Trifluridine Ophthalmic Solution, 1% Sterile DESCRIPTION Trifluridine (also known as trifluorothymidine, F 3 TdR,F 3 T), is an antiviral drug for topical treatment of epithelial keratitis caused by herpes
More informationDisease caused by herpes simplex virus
Recurrence of herpes simplex virus in rabbit eyes: Results of a three-year study Peter R. Laibson and Sidney Kibrick Spontaneous reactivation of herpes simplex virus in rabbit ocular tissue was found on
More informationDouble-masked trial of topical acyclovir and steroids
542 Department of Clinical Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD R J Marsh M Cooper Correspondence to: R J Marsh, FRCS. Accepted for publication 28 February 1991 BritishlournalofOphthalmology,
More informationVIROPTIC Ophthalmic Solution, 1% Sterile (trifluridine ophthalmic solution)
VIROPTIC Ophthalmic Solution, 1% Sterile (trifluridine ophthalmic solution) PRODUCT OVERVIEW: VIROPTIC SOLUTION DESCRIPTION VIROPTIC is the brand name for trifluridine (also known as trifluorothymidine,
More informationEffect of acyclovir on acute and latent herpes simplex virus infections in the rabbit. Melvin D. Trousdale, Edmund C. Dunkel, and Anthony B.
Effect of acyclovir on acute and latent herpes simplex virus infections in the rabbit Melvin D. Trousdale, Edmund C. Dunkel, and Anthony B. Nesburn Acyclovir, a new potent antiviral drug, was used to treat
More informationPossible latent infection with herpes simplex virus in the mouse eye
Journal of General Virology (1990), 71, 2385-2390. Printed in Great Britain 2385 Possible latent infection with herpes simplex virus in the mouse eye C. M. P. Claou~,l*1 " T. J. Hodges, 1 J. M. Darville,
More informationGanciclovir Gel A New Topical Treatment for Herpetic Keratitis
a report by C Stephen Foster, MD Clinical Professor of Ophthalmology, Harvard Medical School DOI: 10.17925/USOR.2007.03.00.52 Herpes simplex virus (HSV) infection of the eye is a major cause of corneal
More informationHerpes Zoster Ophtalmicus in a HIV positive patient: A Case Report
ISPUB.COM The Internet Journal of Neurology Volume 9 Number 2 Herpes Zoster Ophtalmicus in a HIV positive patient: A Case Report G Lopez Bejerano, Y Graza Fernandez Citation G Lopez Bejerano, Y Graza Fernandez..
More informationAPPENDIX II: Corneal Penetration and Median Effective Dose of Antiviral Agents
APPENDIX II: Corneal Penetration and Median Effective Dose of Antiviral Agents Median Effective Dose (ED50) The median effective dose is a statistically derived dose of drug expected to produce a certain
More informationCurrent Concepts in the Management of Herpes Simplex Anterior Segment Eye Disease
Curr Ophthalmol Rep (2013) 1:194 203 DOI 10.1007/s40135-013-0024-2 OCULAR INFECTIONS (BH JENG, SECTION EDITOR) Current Concepts in the Management of Herpes Simplex Anterior Segment Eye Disease Jagadesh
More informationCondition: Herpes Zoster Ophthalmicus (HZO)
Condition: Herpes Zoster Ophthalmicus (HZO) Description: Herpes zoster represents a reactivation of the varicella zoster virus (VZV) which leads to characteristic skin lesions and, in many cases, ocular
More informationEffects of cytarabine on virus shedding in Herpes simplex virus infections
Journal of Antimicrobial Chemotherapy (1977) 3 (Suppl. A), 125-129 Effects of cytarabine on virus shedding in Herpes simplex virus infections Bent Juel-Jensen Department of the Regius Professor of Medicine,
More informationISSN X (Print) Original Research Article. DOI: /sjams
DOI: 10.21276/sjams.2016.4.8.20 Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2016; 4(8B):2825-2829 Scholars Academic and Scientific Publisher (An International Publisher
More informationCORNEAL DENDRITE. What else do you want to know about this patient? What would be your initial treatment?
Viral Keratitis CORNEAL DENDRITE What else do you want to know about this patient? What would be your initial treatment? Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes
More informationWHO Essential Medicines List Ophthalmological Preparations
WHO Essential Medicines List Ophthalmological Preparations 1. Current data Data from the WHO estimated that there were 161 million people in the world with visual impairment of whom 37 million are blind
More informationViroptic (trifluridine) solution [Monarch Pharmaceuticals, Inc.]
Viroptic (trifluridine) solution [Monarch Pharmaceuticals, Inc.] Description VIROPTIC is the brand name for trifluridine (also known as trifluorothymidine, F3TdR,F3T), an antiviral drug for topical treatment
More informationVaricella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus
Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus Helena M. Tabery Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus In Vivo Morphology in the Human Cornea
More informationLearning Objectives:
Viral keratitis and antivirals Learning Objectives: Recognise and distinguish different types of viral keratitis HSV HZO Adenovirus Discuss the use of antiviral agents in the treatment of herpetic infections
More informationWhat are some common conditions that affect the cornea?
What are some common conditions that affect the cornea? Injuries After minor injuries or scratches, the cornea usually heals on its own. Deeper injuries can cause corneal scarring, resulting in a haze
More informationChildhood corneal neovascularization
Miltos Balidis PhD, FEBOphth, ICOphth Sotiria Palioura MD,PhD Childhood corneal neovascularization Opacities Cornea clarity is essential for optimal vision at any age. In childhood, loss of corneal transparency
More informationGENERAL INFORMATION CORNEAL TRANSPLANTATION
GENERAL INFORMATION CORNEAL TRANSPLANTATION WHAT IS CORNEAL TRANSPLANTATION? A corneal transplant is an operation where a damaged or diseased cornea is replaced with donated, healthy tissue. Also called
More informationPhotochemical corneal collagen cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia
Photochemical corneal collagen cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia Issued: September 2013 guidance.nice.org.uk/ipg466 NICE has accredited the process used
More informationClinical Practice Guide for the Diagnosis, Treatment and Management of Anterior Eye Conditions. April 2018
Clinical Practice Guide for the Diagnosis, Treatment and Management of Anterior Eye Conditions This Clinical Practice Guide provides evidence-based information about current best practice in the management
More informationClinical Profile of Herpes Simplex Keratitis
K V Raju MS, Jyothi PT MS, Shimna Iqbal MS Clinical Profile of Herpes Simplex Keratitis Original Article Abstract Aims To document the various clinical presentations and to assess the risk factors contributing
More informationInterventional procedures guidance Published: 25 September 2013 nice.org.uk/guidance/ipg466
Photochemical corneal collagen cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia Interventional procedures guidance Published: 25 September 2013 nice.org.uk/guidance/ipg466
More informationSclerokeratoplasty David S. Chu, M.D. Cases
Sclerokeratoplasty David S. Chu, M.D. Cases Case 1 40 year-old female from Peru presented to our Service with inflamed OS for 2 months duration. Her symptoms began as red painful OS, which progressively
More informationPATIENT INFORMATION ON CORNEAL GRAFT
PATIENT INFORMATION ON CORNEAL GRAFT (TRANSPLANT) SURGERY M ANANDAN What is the cornea? The clear window of the eye approximately 0.5mm thick and 12mm across. It lies in front of the fluid filled anterior
More informationHSV DNA replication. Herpesvirus Latency. Latency and Chemotherapy. Human Herpesviruses - subtypes. Acyclovir (acycloguanosine) {Zovirax}
Human Herpesviruses - subtypes Herpes Simplex I (HSVI) - herpes labialis (cold sores) herpes keratitis (eye infections) HSVII - herpes genitalis (genital herpes) Varicella Zoster virus (VZV) Chicken pox
More informationEffects of deep lamellar keratoplasty on severe necrotizing stromal keratitis.
Biomedical Research 2018; 29 (4): 702-707 ISSN 0970-938X www.biomedres.info Effects of deep lamellar keratoplasty on severe necrotizing stromal keratitis. Xiaoru Shi, Yang Liu, Hui Jia, Lei Liu, Chunmei
More informationCLINICAL PHARMACOLOGY
VIROPTIC- trifluridine solution Pfizer Laboratories Div Pfizer Inc ---------- VIROPTIC Ophthalmic Solution, 1% Sterile (trifluridine ophthalmic s olution) DESCRIPTION VIROPTIC is the brand name for trifluridine
More informationOcular herpes simplex
Ocular herpes simplex David C. Brown Herpes simplex keratitis is a leading cause of blindness and disability. Much information has been obtained from recent experimental and clinical observations. These
More informationEYE CARE PROTOCOL FOR PATIENTS IN ITU
EYE CARE PROTOCOL FOR PATIENTS IN ITU Back to contents Developed by SUE LIGHTMAN PROFESSOR OF CLINICAL OPHTHALMOLOGY/CONSULTANT OPHTHALMOLOGIST MOORFIELDS EYE HOSPITAL Amended for UCLU ICU by Caroline
More informationHERPES SIMPLEX VIRUS (HSV)
CLINICAL SCIENCES Modalities to Decrease Stromal Herpes Simplex Keratitis Reactivation Rates John D. Sheppard, MD; Michael L. Wertheimer, MD; Stephen V. Scoper, MD Objective: To evaluate the efficacy of
More informationHerpes simplex virus (HSV) stromal keratitis is the leading infectious cause of corneal blindness in
Herpes Simplex Epithelial Keratitis and Proposed Treatments Andrea De Souza, OD I. Introduction Author s Bio Dr. Andrea De Souza received her Doctor of Optometry Degree in 2012 from the New England College
More informationHerpes simplex virus type 1 (HSV-1) is the leading cause
Comparative Antiviral Efficacies of Cidofovir, Trifluridine, and Acyclovir in the HSV-1 Rabbit Keratitis Model Eric G. Romanowski, 1 Stephen P. Bartels, 2 and Y.Jerold Gordon 1 PURPOSE. TO determine the
More informationHistory. Examination. Diagnosis/Course
History A 51 year-old female with a history of chronic dry eyes and photosensitivity was referred for evaluation. She reported a five year history of symptoms of frequent irritation and photophobia in
More informationVarious Landmark. Clinical Clinical Trials: Trials: Cornea. Cornea is the first refractive media and also is the major. Sandeep Gupta MS,DNB
Clinical Clinical Trials: Trials: Cornea Various Landmark Corneal Clinical Trials Sandeep Gupta MS,DNB Sandeep Gupta MS,DNB, Parth Patel MBBS, B.V. Rao MS,DNB, Gagandeep Kaur MBBS, V.S. Gurunadh MS, M.A.
More informationStructure of viruses
Antiviral Drugs o Viruses are obligate intracellular parasites. o lack both a cell wall and a cell membrane. o They do not carry out metabolic processes. o Viruses use much of the host s metabolic machinery.
More informationDepartment of Ophthalmology
Department of Ophthalmology Period : 02/July/18 to 30/August/18 Semester : 7 th Semester Lecture Lesson Plan Sr. Date Topic Lesson plan Name of Faculty No. 1 02.07.18 Lens- Lens-Anatomy, Classification
More informationThe Severity of Herpes Simplex Viral Keratitis in Mice Does Not Reflect the Severity of Disease in Humans
Investigative Ophthalmology & Visual Science, Vol. 33, No. 2, February 992 Copyright Association for Research in Vision and Ophthalmology The Severity of Herpes Simplex Viral Keratitis in Mice Does Not
More informationDr.saifalshamarti. Objective. Where is cornea? Functions of the cornea
Cornea Dr.saifalshamarti Objective Functions Anatomy: detailed description of the 5 layers: epithelium, Bowman s layer, stroma, Descement s membrane, endothelium. Diseases of the cornea: - infection: bacterial
More informationLamellar Keratoplasty for the Treatment of Fungal Keratitis
Cornea 21(1): 33 37, 2002. 2002 Lippincott Williams & Wilkins, Inc., Philadelphia Lamellar Keratoplasty for the Treatment of Fungal Keratitis Lixin Xie, M.D., Weiyun Shi, M.D., Zhaosheng Liu, M.D., and
More informationSubject Index. Atopic keratoconjunctivitis (AKC) management 16 overview 15
Subject Index Acanthamoeba keratitis, see Infective keratitis Acute allergic conjunctivitis AKC, see Atopic keratoconjunctivitis Allergy acute allergic conjunctivitis 15 atopic keratoconjunctivitis 15
More informationAcanthamoeba keratitis associated with contact
British Journal of Ophthalmology, 1989, 73, 271-275 Acanthamoeba keratitis associated with contact lenses: six consecutive cases of successful management MARY BETH MOORE AND JAMES P McCULLEY From the Department
More informationSpecialist Referral Service Willows Information Sheets. Recurrent corneal erosions (indolent ulcers)
Specialist Referral Service Willows Information Sheets Recurrent corneal erosions (indolent ulcers) A rabbit s cornea undergoing debridement under topical anaesthesia Recurrent corneal erosions (indolent
More informationDr. D. Y. Patil Medical College, Pimpri, Pune
Dr. D. Y. Patil Medical College, Pimpri, Pune - 411 018 Period : 04/July/16 to 22/September/16 Semester : 7 th Semester Department : Ophthalmology Lecture Lesson Plan Sr No Date Topic Learning objectives
More informationDr Jo-Anne Pon. Dr Sean Every. 8:30-9:25 WS #70: Eye Essentials for GPs 9:35-10:30 WS #80: Eye Essentials for GPs (Repeated)
Dr Sean Every Ophthalmologist Southern Eye Specialists Christchurch Dr Jo-Anne Pon Ophthalmologist Southern Eye Specialists, Christchurch Hospital, Christchurch 8:30-9:25 WS #70: Eye Essentials for GPs
More informationInnovation In Ophthalmology
Innovation In Ophthalmology INVELTYS TM Approval August 2018 Disclaimers and Notices This presentation contains forward-looking statements within the meaning of the Private Securities Litigation Reform
More informationViral keratitis Mark Daniell Head of Cornea RVEEH
Viral keratitis Mark Daniell Head of Cornea RVEEH Typical presentation 77year old man 4 weeks right eye red and painful. POH Nil PMHx: HTN, osteoporosis, obesity VAR HM, VAL 6/6-3 IOP R 15, L 8 Microbial
More informationDepartment of Ophthalmology
Period : 03/July/17 to 07/September/17 Semester : 7 th Semester Department of Ophthalmology Lecture Lesson Plan Sr 1 03.07.17 Uvea-Anatomy, Uvea-Anatomy, Classification of Uveitis Dr R Paranjpe Classification
More informationFUCH S DYSTROPHY & CATARACT SURGERY TREATMENT ALGORITHM
FUCH S DYSTROPHY & CATARACT SURGERY TREATMENT ALGORITHM ΙΟΑΝΝΙS Α. MALLIAS, MD, PHD Director of the Dept. of Ophthalmology, Mediterraneo Hospital, Glyfada, Athens, Greece Clinical Fellow in Cornea and
More informationHerpes zoster. Diagnosis, Complications, Treatment, Prevention 서울대학교병원 FM R2 임하연
Herpes zoster Diagnosis, Complications, Treatment, Prevention 2018.04.14 서울대학교병원 FM R2 임하연 1 2 Overview reactivation of lat ent VZV along sensory nerve VZV(varicella-zoster virus) Human herpes virus-3
More informationAn Injector s Guide to OZURDEX (dexamethasone intravitreal implant) 0.7 mg
An Injector s Guide to OZURDEX (dexamethasone intravitreal implant) 0.7 mg This guide is intended to provide injectors with information on the recommended injection technique and the important risks related
More informationHerpes Simplex Viruses: Disease Burden. Richard Whitley The University of Alabama at Birmingham Herpes Virus Infection and Immunity June 18-20, 2012
Herpes Simplex Viruses: Disease Burden Richard Whitley The University of Alabama at Birmingham Herpes Virus Infection and Immunity June 18-20, 2012 Mucocutaneous HSV Infections Life-Threatening HSV Diseases
More informationRecovery of Herpes Simplex Virus From Oculor Tissues of Latently Infected Inbred Mice
Investigative Ophthalmology & Visual Science, Vol. 29, No. 2, February 1988 Copyright Association for Research in Vision and Ophthalmology Recovery of Herpes Simplex Virus From Oculor Tissues of Latently
More informationrhngf for neurotrophic keratitis first line
September 2015 Horizon Scanning Research & Intelligence Centre rhngf for neurotrophic keratitis first line LAY SUMMARY This briefing is based on information available at the time of research and a limited
More informationINDICATIONS For steroid responsive inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the eye globe.
Page 1 of 5 SCHEDULING STATUS Schedule 4 PROPRIETARY NAME AND DOSAGE FORM PRED FORTE Sterile Eye Suspension COMPOSITION PRED FORTE Sterile Eye Suspension contains: Prednisolone acetate 10 mg/ml Preservative:
More information5/24/17. ***Varicella-Zoster Virus*** Herpes DNA virus that causes 2 distinct syndromes
Nathan Lighthizer, O.D., F.A.A.O. Assistant Dean, Clinical Care Services Director of Continuing Education Chief of Specialty Care Clinics Chief of Electrodiagnostics Clinic Oklahoma College of Optometry
More information1/3/17. ***Varicella-Zoster Virus*** Herpes DNA virus that causes 2 distinct syndromes
Nathan Lighthizer, O.D., F.A.A.O. Assistant Dean, Clinical Care Services Director of Continuing Education Chief of Specialty Care Clinics Chief of Electrodiagnostics Clinic Oklahoma College of Optometry
More informationUCSF UC San Francisco Previously Published Works
UCSF UC San Francisco Previously Published Works Title Unilateral Posterior Interstitial Keratitis as a Clinical Presentation of Herpes Simplex Virus Disease. Permalink https://escholarship.org/uc/item/8970f2fq
More informationProceedings of the World Small Animal Veterinary Association Sydney, Australia 2007
Proceedings of the World Small Animal Sydney, Australia 2007 Hosted by: Next WSAVA Congress MANAGEMENT OF CORNEAL ULCERS IN SMALL ANIMALS Robin G Stanley, BVSc(Hons), FACVSc-Ophthalmology Animal Eye Care
More informationPost-LASIK infections
Post-LASIK infections By Mohamed El-moddather Assiss. Prof. and head of department of ophthalmology AL-Azhar unizersity Assuit LASIK has become a common refractive procedure and is generally considered
More informationThe side effects of corticosteroids. Bernard Becker
The side effects of corticosteroids Bernard Becker C, 'orticosteroids are of enormous value in the suppression of the ocular inflammatory reaction to various injurious agents. The administration of corticosteroids
More informationCURRICULUM VITAE Shahla Z. Abghari
Shahla Z. Abghari, Ph. D. Updated March 4, 2014 PAGE 1 CURRICULUM VITAE Shahla Z. Abghari U. S. CITIZENSHIP: April 1992 EDUCATION: 1966-1970 B.S., Biology, Teachers University, Tehran, Iran 1967-1971 B.A.,
More informationSCHEDULING STATUS Schedule 4 PROPRIETARY NAME AND DOSAGE FORM
Page 1 of 5 SCHEDULING STATUS Schedule 4 PROPRIETARY NAME AND DOSAGE FORM FML Liquifilm Sterile Eye Suspension COMPOSITION FML Liquifilm Sterile Eye Suspension contains: Fluorometholone 1,0 mg/ml Liquifilm
More informationEpidemiological and clinical features of primary herpes simplex virus ocular infection
British Journal of Ophthalmology, 1985, 69, 2-6 Epidemiological and clinical features of primary herpes simplex virus ocular infection S DAROUGAR, M S WISHART, AND N D VISWALINGAM From the Subdepartment
More informationHerpetic Eye Diseases
Herpetic Eye Diseases Documenta Ophthalmologica Proceedings Series volume 44 Editor H. E. Henkes Herpetic Eye Diseases Proceedings of the International Symposium at the Katholieke Universiteit Leuven,
More informationSpread of Virus and Distribution of Latent Infection Following Ocular Herpes Simplex in the Non-immune and Immune Mouse
J. gen. Virol. (1982), 63, 95-101. Printed in Great Britain Key words: ocular HSV/latent infection/trigeminal ganglion 95 Spread of Virus and Distribution of Latent Infection Following Ocular Herpes Simplex
More informationAcute Herpetic Keratitis: What is the Role for Ganciclovir Ophthalmic Gel?
Acute Herpetic Keratitis: What is the Role for Ganciclovir Ophthalmic Gel? The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters. Citation
More informationAn outbreak of adenovirus keratoconjunctivitis in Bristol
British Journal of Ophthalmology, 1979, 63, 621-626 An outbreak of adenovirus keratoconjunctivitis in Bristol A. B. TULLO,1 AND P. G. HIGGINS2 From the 'Bristol Eye Hospital, Lower Maudlin Street, Bristol
More informationD90 (27/10/2005) Final SmPC NL/H/653/01
1/6 1. NAME OF THE MEDICINAL PRODUCT MONOFREE DEXAMETHASON 1 mg/ml, eye drops, solution 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 ml solution contains 1 mg of dexamethasone phosphate as dexamethasone
More informationPhotodynamic therapy for IMMK in horses
Photodynamic therapy for IMMK in horses Overview Immune mediated keratitis in horses Traditional treatment options Sustained release implant Photodynamic therapy Use in veterinary medicine Treatment for
More informationManagement of acute ulcerative and necrotising herpes simplex and zoster keratitis with amniotic membrane transplantation
1215 SCIENTIFIC REPORT Management of acute ative and necrotising herpes simplex and zoster keratitis with amniotic membrane transplantation A Heiligenhaus, H Li, E E Hernandez Galindo, J M Koch, K-P Steuhl,
More information10 EYE EMERGENCIES. Who goes, who you better not send! Brant Slomovic, MD, FRCPC University Health Network
10 EYE EMERGENCIES Who goes, who you better not send! Brant Slomovic, MD, FRCPC University Health Network DISCLOSURES I have none PVD CASE 1 WHAT IS A PVD? a process of aging (45-55) liquefaction of vitreous
More informationAging & Ophthalmology
Aging & Ophthalmology Pr Jean-Marie Rakic Dr Denis Malaise January 2018 Major ocular diseases 1. Cataract 2. Age-related macular degeneration 3. Ischemic optic neuropathy 4. Horton arteritis 5. Glaucoma
More informationHerpes simplex virus keratitis: an update of the pathogenesis and current treatment with oral and topical antiviral agents
Review Herpes simplex virus keratitis: an update of the pathogenesis and current treatment with oral and topical antiviral agents Short running title: Herpes simplex virus keratitis and antiviral agents
More informationAcanthamoeba keratitis: risk factors and outcome
1078 B?itishJournal of Ophthalmology 1995; 79: 1078-1082 Department of Ophthalmology, Bristol Eye Hospital, Bristol C D Illingworth S D Cook C H Karabatsas D L Easty Correspondence to: Mr S D Cook, Bristol
More informationConjunctivitis in Cats
Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Conjunctivitis in Cats (Inflammation of the Moist Tissues of the Eye) Basics OVERVIEW
More informationINVELTYS (loteprednol etabonate ophthalmic suspension) 1%, for topical ophthalmic use Initial U.S. Approval: 1998
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use INVELTYS safely and effectively. See full prescribing information for INVELTYS. INVELTYS (loteprednol
More informationCorneal transplant (Endothelial graft)
Corneal transplant (Endothelial graft) What is a corneal transplant? The cornea is the transparent window at the front of the eye, and it can become scarred by injury or turn cloudy due to disease, when
More informationSOCIOECONOMICS AND HEALTH SERVICES SECTION EDITOR: PAUL P. LEE, MD. Prevention of Herpes Simplex Virus Eye Disease
SECTION EDITOR: PAUL P. LEE, MD Prevention of Herpes Simplex Virus Eye Disease A Cost-effectiveness Analysis SOCIOECONOMICS AND HEALTH SERVICES David R. Lairson, PhD; Charles E. Begley, PhD; Thomas F.
More informationPostoperative follow up and treatment after refractive surgery
Postoperative follow up and treatment after refractive surgery George Kontadakis, MD, MSc, PhD Institute of Vision and Optics and Department of Ophthalmology University of Crete Target of postoperative
More informationClinical Features of Herpes Simplex Keratitis in a Korean Tertiary Referral Center: Efficacy of Oral Antiviral and Ascorbic Acid on Recurrence
pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2018;32(5):353-360 https://doi.org/10.3341/kjo.2017.0131 Original Article Clinical Features of Herpes Simplex Keratitis in a Korean Tertiary Referral
More informationClinical Study Conjunctival Flap Covering Combined with Antiviral and Steroid Therapy for Severe Herpes Simplex Virus Necrotizing Stromal Keratitis
e Scientific World Journal Volume 2015, Article ID 565964, 6 pages http://dx.doi.org/10.1155/2015/565964 Clinical Study Conjunctival Flap Covering Combined with Antiviral and Steroid Therapy for Severe
More informationCorneal blood staining after hyphaema
Brit. J_. Ophthal. (I 972) 56, 589 after hyphaema J. D. BRODRICK Sheffield has been described as a rare complication of contusion injury in which a hyphaema of relatively long duration and a raised intraocular
More information