title: Clinical efficacy of oral and topical acyclovir in herpes simplex virus stromal necrotizing keratitis.
abstract: OBJECTIVE
  To evaluate the efficacy of systemic and topical antiviral therapy in the treatment of active herpes simplex virus (HSV) necrotizing stromal keratitis (NSK).
  
  
  METHODS
  Prospective interventional case series.
  
  
  METHODS
  Patients with a diagnosis of HSV NSK based on history and clinical findings were enrolled in the study. A standard protocol was used for microbiologic investigations. Ten weeks regime of systemic acyclovir and 2 weeks of topical acyclovir was given. Complete ophthalmic examination was performed at every visit. Outcome measures were a reduction in the area of infiltration and improvement in visual acuity.
  
  
  RESULTS
  Fifteen patients were enrolled in the study. The mean age of presentation was 51.53 years. The duration of symptoms at presentation ranged from 2 to 8 weeks. HSV1 DNA polymerase chain reaction was positive in 70% cases of those tested. Area of infiltration at trial entry and at the end of 2 weeks of antiviral treatment reduced significantly (P = 0.007). All patients showed a complete resolution of keratitis at the end of study.
  
  
  CONCLUSIONS
  Topical and systemic acyclovir for treatment of NSK facilitates healing of ulceration. Topical steroids after initial antiviral therapy are safe and decreases inflammation and improve visual recovery. Early initiation of therapy has better outcomes as compared to late presentations.
authors.affiliation: Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
authors.forename: Surabhi
authors.initials: S
authors.lastname: Dutt
authors.affiliation: Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Acharya
authors.affiliation: Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
authors.forename: Abha
authors.initials: A
authors.lastname: Gour
authors.affiliation: Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
authors.forename: Neelam
authors.initials: N
authors.lastname: Sapra
authors.affiliation: Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Chauhan
authors.affiliation: Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
authors.forename: Umang
authors.initials: U
authors.lastname: Mathur
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage*; D000287:Administration, Topical; D000998:Antiviral Agents / Q000008:administration & dosage; D003315:Cornea / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D016849:Keratitis, Herpetic / Q000188:drug therapy* / Q000821:virology; D008297:Male; D009336:Necrosis / Q000188:drug therapy / Q000821:virology; D011446:Prospective Studies; D018139:Simplexvirus / Q000235:genetics; D014792:Visual Acuity
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir