title: Evaluation of therapeutic interventions for vaccinia virus keratitis.
abstract: BACKGROUND
  Vaccinia virus keratitis (VACVK) is a complication of smallpox vaccination that can result in blindness. There are no Food and Drug Administration-approved treatments for VACVK, and vaccinia immunoglobulin (VIG) is contraindicated in isolated VACVK. We used a rabbit model of infection to compare several therapeutic options for VACVK.
  
  
  METHODS
  Rabbit eyes were infected with 10(5) plaque-forming units of the Dryvax strain of vaccinia virus and scored daily for 28 days using a modified MacDonald-Shadduck scoring system. Animals were treated for 10 days after the onset of keratitis with albumin, VIG, prednisolone acetate, trifluridine, or combinations thereof. Ocular viral titers and vaccinia-specific antibody titers were determined by plaque assay and enzyme-linked immunosorbent assay, respectively.
  
  
  RESULTS
  Treatment with intravenous VIG neither exacerbated nor ameliorated VACVK. Topical prednisolone acetate interfered with viral clearance, and ocular disease rebounded in prednisolone-treated groups. The most effective treatment was topical trifluridine alone.
  
  
  CONCLUSIONS
  We conclude that (1) VIG did not negatively affect the treatment of isolated keratitis, (2) topical corticosteroids should not be used for treating VACVK, and (3) treatment with topical trifluridine, with or without intravenous VIG, is the preferred therapeutic regimen for treating VACVK.
authors.affiliation: Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, WI 53706, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Altmann
authors.forename: Curtis R
authors.initials: CR
authors.lastname: Brandt
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Murphy
authors.forename: Ravi
authors.initials: R
authors.lastname: Patnaikuni
authors.forename: Teresa
authors.initials: T
authors.lastname: Takla
authors.forename: Megan
authors.initials: M
authors.lastname: Toomey
authors.forename: Brittany
authors.initials: B
authors.lastname: Nesbit
authors.forename: Kimberly
authors.initials: K
authors.lastname: McIntyre
authors.forename: Jill
authors.initials: J
authors.lastname: Covert
authors.forename: Richard
authors.initials: R
authors.lastname: Dubielzig
authors.forename: Gary
authors.initials: G
authors.lastname: Leatherberry
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Adkins
authors.forename: Shantha
authors.initials: S
authors.lastname: Kodihalli
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D000914:Antibodies, Viral / Q000096:biosynthesis / Q000097:blood; D000998:Antiviral Agents / Q000494:pharmacology; D001766:Blindness / Q000209:etiology / Q000517:prevention & control / Q000821:virology; D002522:Chlorocebus aethiops; D003315:Cornea / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006367:HeLa Cells; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007634:Keratitis / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D011239:Prednisolone / Q000031:analogs & derivatives / Q000494:pharmacology; D011817:Rabbits; D011897:Random Allocation; D012900:Smallpox Vaccine / Q000009:adverse effects*; D014271:Trifluridine / Q000494:pharmacology; D014616:Vaccinia virus / Q000276:immunology / Q000302:isolation & purification; D014709:Vero Cells
chemical_list: D000893:Anti-Inflammatory Agents; D000914:Antibodies, Viral; D000998:Antiviral Agents; D007136:Immunoglobulins; D012900:Smallpox Vaccine; C009935:prednisolone acetate; D011239:Prednisolone; D014271:Trifluridine