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A.L. Kronenberg, J. Primack, R. Rothman, S. Mandelbaum, I. Udell; Protective Effect of Long Term Acyclovir in the Management of HSV Keratitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1389.
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Purpose: To evaluate the benefit of long term oral acyclovir on the recurrence rate of herpetic epithelial, stromal, and uveitic eye disease. Methods: A retrospective chart review of patients with herpetic epithelial, stromal, and uveitic eye disease who were treated with oral acyclovir for greater than 1 year. Patient data included age, sex, type of clinical course, number of recurrences before and after antiviral treatment, and length of time on acyclovir. Results: The study consisted of 31 patients, 42% men and 58% women with a mean age of 68 (range 21-93). Patients were followed for a mean of 103.4 months (range, 21-336). They were treated with oral acyclovir for a mean of 54.4 months (range, 15-168). Eleven patients (35.5%) had a history of penetrating keratoplasty and 20 patients (64.5%) did not. There was an average of 3.5 recurrences prior to initiation of oral acyclovir (range, 1-12), and an average of 0.9 recurrences after treatment (range, 0-4). The average number of recurrences after 1 year of treatment was 0.3 (range, 0-1) with n= 31, at 3 years was 0.5 (range, 0-2) with n= 24, and at 5 years was 0.8 (range, 0-4) with n= 18. No statistically significant increase in the number of recurrences was noted after 1 year of oral acyclovir treatment compared to 3 years of treatment (Pearson chi square=0.002) or compared to 5 years of treatment (Pearson chi square=0.01). There was no significant difference in the number of recurrences on acyclovir treatment in patients with a history of penetrating keratoplasty (t-test 0.67). Length of time between the first episode of herpetic eye disease and the initiation of treatment with oral acyclovir did not correlate with the total number of recurrences while on acyclovir. No patients reported toxicity secondary to treatment. Conclusions: Oral acyclovir appears to be effective in reducing the total recurrence rates of ocular HSV disease at 1, 3, and 5 years.
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