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D. Goldblum, C. Bachmann, C. Tappeiner, J. Garweg, B. E. Frueh; Comparison of Oral Antiviral Therapy With Valacyclovir or Acyclovir After Penetrating Keratoplasty for Herpetic Keratitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2347.
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© ARVO (1962-2015); The Authors (2016-present)
To determine and compare the outcomes of prophylactic oral valacyclovir (VAL) against the common oral acyclovir treatment (ACV) in patients having undergone penetrating keratoplasty for herpetic keratitis.
We retrospectively evaluated the records from all patients having received a penetrating keratoplasty for herpes keratitis and being treated postoperatively with either oral VAL or oral ACV. Medical records were analyzed for history of recurrent herpetic keratitis, neovascularization, rejection, endothelial cell loss, central corneal thickness, visual acuity with a follow-up of up to 5 years after surgery.
20 patients received VAL and were compared with 19 patients being treated with ACV. Two Patients developed clinical signs of recurrent herpetic disease in the VAL group compared to three patients in the ACV group. Five patients in the ACV and two in the VAL group developed rejection episodes and two patients from both groups suffered an irreversible graft failure. Best corrected visual acuity improved in both treatment groups from baseline -1.97 VAL; -1.47 ACV (log MAR) to -0.85; -0.72 respectively at 1 year follow-up whereas at 5 year follow-up the visual acuity slightly deteriorated again in the ACV group (-0.71 VAL vs. -1.14 ACV).
Prophylactic oral VAL treatment is at least as effective as the established ACV regimen in decreasing the recurrence of herpetic keratitis and graft failure in patients who underwent corneal transplantation for herpes keratitis. Tolerability of the two drugs are similar, but the dosing schedule of VAL might be easier for the patients.
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