Risk factors for herpes simplex virus epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
OBJECTIVE
Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis.


METHODS
The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks.


RESULTS
Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis.


CONCLUSIONS
Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.
Wilhelmus
K R
KR
Francis I Proctor Foundation, University of California San Francisco 94143-1412, USA.
Dawson
C R
CR
Barron
B A
BA
Bacchetti
P
P
Gee
L
L
Jones
D B
DB
Kaufman
H E
HE
Sugar
J
J
Hyndiuk
R A
RA
Laibson
P R
PR
Stulting
R D
RD
Asbell
P A
PA
D000212:Acyclovir / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004728:Endothelium, Corneal / Q000821:virology*; D005260:Female; D006801:Humans; D015863:Iridocyclitis / Q000188:drug therapy* / Q000821:virology; D007635:Keratitis, Dendritic / Q000209:etiology; D016849:Keratitis, Herpetic / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D014271:Trifluridine / Q000009:adverse effects / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D011239:Prednisolone; D014271:Trifluridine; D000212:Acyclovir