Topical ganciclovir in the treatment of acute herpetic keratitis.
Herpetic keratitis is caused by herpes simplex virus (HSV) and is a common cause of corneal blindness. Following a primary ocular herpetic infection, latency of the virus occurs, followed by subsequent recurrences of herpetic keratitis. Such recurrences may lead to structural damage of the cornea. Recurrent herpetic keratitis is a common indication for corneal transplantation. Recurrences of herpetic keratitis in the corneal graft may lead to corneal graft rejection. Several antiviral agents for HSV are available, including the thymidine analogs. Prolonged use of thymidine analogs may lead to toxicity of the ocular surface, including epithelial keratitis, corneal ulcers, follicular conjunctivitis, and punctal occlusions. Availability of topical antiviral agents that are safe and effective in the treatment and prophylaxis of herpetic keratitis is highly desirable. Ganciclovir is a potent inhibitor of members of the herpes virus family. The drug has been used systemically for the treatment of cytomegalovirus (CMV) retinitis. Its hematologic toxicity secondary to systemic administration led to its limited use in herpetic infections. On the other hand, topical ganciclovir has been shown to be as safe and effective as acyclovir in the treatment of herpetic epithelial keratitis. Furthermore, topical ganciclovir can reach therapeutic levels in the cornea and aqueous humor following topical application. Several clinical trials have shown that topical ganciclovir 0.15% ophthalmic gel is safe and effective in the treatment and prophylaxis of herpetic epithelial disease. Long-term use of ganciclovir ophthalmic gel in patients with penetrating keratoplasty following herpetic keratitis has prevented recurrences of the disease. Topical ganciclovir ophthalmic gel is well tolerated, does not cause toxic effects on the ocular surface, and does not cause hematologic abnormalities. Clinical studies have underscored the potential role of ganciclovir ophthalmic gel in the treatment and prophylaxis of herpetic epithelial keratitis. Future randomized, controlled, multicenter, prospective clinical trials are needed to assess the long-term safety and efficacy of topical ganciclovir in the treatment and prevention of herpetic keratitis and uveitis.
Tabbara
Khalid F
KF
The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Kingdom of Saudi Arabia. k.tabbara@nesma.net.sa
Al Balushi
Noorjehan
N
Ocul Immunol Inflamm. 1999 Mar;7(1):51-60
10410875
Int Ophthalmol. 2008 Jun;28(3):223-32
17634865
Curr Eye Res. 1987 Jan;6(1):247-53
3030646
Antivir Chem Chemother. 2001 May;12(3):175-86
12959326
Antiviral Res. 1987 Feb;7(2):119-25
3495237
Ophthalmology. 1994 Dec;101(12):1871-82
7997323
Br J Ophthalmol. 2010 Dec;94(12):1648-52
20576767
Ophthalmology. 1987 Aug;94(8):935-44
3309775
Clin Ophthalmol. 2007 Dec;1(4):441-53
19668521
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD002898
17253484
Trans Am Ophthalmol Soc. 2000;98:505-32
11190039
N Engl J Med. 1998 Jul 30;339(5):300-6
9696640
Ophthalmology. 1989 Nov;96(11):1587-96
2694048
Am J Ophthalmol. 1990 Jun 15;109(6):689-95
2346198
J Ocul Pharmacol Ther. 2005 Dec;21(6):463-74
16386088
Am J Med. 1988 Aug 29;85(2A):14-9
3044076
J Med Virol. 1993;Suppl 1:45-50
8245892
Med Oral Patol Oral Cir Bucal. 2011 Jan 01;16(1):e15-8
20526251
J Fr Ophtalmol. 2004 May;27(5):547-57
15179314
Arch Ophthalmol. 2003 Jan;121(1):108-12
12523894
J Infect Dis. 1994 Jun;169(6):1338-41
8195614
Cornea. 1997 Jul;16(4):393-9
9220235
Ophthalmology. 1992 Dec;99(12):1805-8
1336155
Ophthalmology. 2005 Sep;112(9):1640
16139674
Arch Ophthalmol. 2000 Aug;118(8):1030-6
10922194
Curr Eye Res. 1987 Jan;6(1):241-5
3030645
Cornea. 2001 Mar;20(2):187-90
11248827
Br J Ophthalmol. 1996 Feb;80(2):140-3
8814744
J Immunol. 2010 Feb 15;184(4):1867-75
20089700
J Ocul Pharmacol. 1994 Summer;10(2):439-51
8083563