Effect of oral valaciclovir on herpetic keratitis.
OBJECTIVE
To examine the efficacy of valaciclovir (VACV) oral formulation as an alternative to topical treatments in a case of herpetic keratitis.


METHODS
The patient was a 61-year-old man who presented with dendritic keratitis in his left eye. After recognizing his difficulty in using eye ointment, we prescribed oral VACV 500 mg tablets twice daily for 7 days. We also describe our experiments with orally administered VACV in a mouse model of this disease. In this study, 143 Balb/c mice were inoculated with herpes simplex virus type 1 (HSV)-1 in each eye and treated with oral VACV 50 or 100 mg/kg twice daily, oral acyclovir (ACV) 50 mg/kg 5 times/d, 3% ACV eye ointment (ACV-O) 5 times/d, 3% ACV eye drops 5 times/d, or control for 5 days.


RESULTS
After 7 days, the patient's lesion was observed healed. Corrected left visual acuity was also improved, and HSV DNA was below detectable level. In the mouse study, slit-lamp examination on days 3, 4, 5, and 7 revealed that all 5 ACV and VACV treatment groups were significantly more effective in improving symptoms of herpetic epithelial keratitis versus control (P < 0.05). Moreover, VACV 100 mg/kg was superior to other treatments. Viral titers in mouse eyeball and trigeminal ganglia were lowest in the VACV 100 mg/kg group versus other treatment groups.


CONCLUSIONS
Our case example suggests that when frequent application, blurred vision, and foreign body sensation after ACV-O application cause difficulty for patients to follow treatment, oral VACV might be an effective and safe option for patients with herpetic keratitis.
Higaki
Shiro
S
Department of Ophthalmology, Kinki University School of Medicine, 377-2 Ohno Higashi, Osaka Sayama City, Osaka, Japan. higaki@ganka.med.kindai.ac.jp
Itahashi
Motoki
M
Deai
Tatsunori
T
Fukuda
Masahiko
M
Shimomura
Yoshikazu
Y
D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000284:Administration, Oral; D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use*; D003315:Cornea / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D004195:Disease Models, Animal; D018628:Gene Dosage; D018259:Herpesvirus 1, Human / Q000235:genetics; D006801:Humans; D007635:Keratitis, Dendritic / Q000188:drug therapy* / Q000821:virology; D016849:Keratitis, Herpetic / Q000188:drug therapy; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011355:Prodrugs / Q000627:therapeutic use; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000998:Antiviral Agents; D004279:DNA, Viral; D011355:Prodrugs; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir