Modalities to decrease stromal herpes simplex keratitis reactivation rates.
OBJECTIVE
To evaluate the efficacy of adjunctive treatments to decrease herpes simplex keratitis (HSK) recurrences in patients with simultaneous stromal HSK and dry eye disease.


METHODS
This was a nonrandomized, single-center, retrospective, comparative analysis. Forty-two patients were diagnosed with unilateral HSK and dry eye disease. Of the 42 patients, 22 were treated with ipsilateral punctal occlusion by thermal cautery and 10 were treated with topical administration of cyclosporine, 0.05%, ophthalmic emulsion twice a day. Another group of 10 patients had previously undergone punctal occlusion and had cyclosporine ophthalmic emulsion twice a day added. All patients continued the use of oral acyclovir or valacyclovir hydrochloride and topical steroids. The frequency and duration of HSK recurrences were monitored for 1 year after initiation of treatment, and the rates were compared with those in the prior year.


RESULTS
The thermal cautery and topical cyclosporine groups experienced HSK recurrences for mean durations of 7.1 and 5.8 mo/y before treatment, respectively, and these were reduced to 1.1 mo/y after treatment in both groups. Topical administration of cyclosporine further reduced the duration of HSK recurrences in patients with prior thermal cautery from an average of 1.3 mo/y before the addition of cyclosporine to 0.8 mo/y after the addition of cyclosporine.


CONCLUSIONS
Permanent punctal occlusion by thermal cautery and the use of topical cyclosporine independently reduced recurrences of stromal HSK.
Sheppard
John D
JD
Thomas R. Lee Center for Ocular Pharmacology, Eastern Virginia Medical School, Norfolk, USA. docshep@hotmail.com
Wertheimer
Michael L
ML
Scoper
Stephen V
SV
D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000287:Administration, Topical; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000821:virology*; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D015352:Dry Eye Syndromes / Q000628:therapy*; D004564:Electrocoagulation / Q000379:methods; D005143:Eyelids / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D018259:Herpesvirus 1, Human / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016849:Keratitis, Herpetic / Q000517:prevention & control* / Q000821:virology; D007765:Lacrimal Apparatus / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014775:Virus Activation
D000998:Antiviral Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir