Autologous Serum vs Topical Acyclovir in the Treatment of Epithelial Herpetic Keratitis

Abstract

Purpose:: Compare the treatment of autologous serum vs. topical acyclovir in epithelial herpetic keratitis.

Methods:: We included patients with epithelial herpetic keratitis. Group I was treated with 20% diluted autologous serum eyedrops q.i.d. Autologous serum was obtained by the technique described by Tsubota and cols. Group II was treated with topical acyclovir q.i.d. Treatment failure was considered when both treatments had to be associated or when a patient presented a corneal perforation. Re-epithelialization was measured and recorded in mm².

Results:: 17 eyes of 17 patients were studied; 9 were in group I, and 8 in group II. In group I we had 5 ameboid; 3 dendritic and 1 oval ulcers; with an average size of ulcer of 1.8 mm² (range of 0,35 to 4.5 mm²). Re-epithelialization with monotherapy was present in 6 patients, an average size of the ulcer was 1.1 mm², (range of 0,35 to 2 mm ²), remission occurred by day 10, range of 9 to 12 days; the average of remission was 0,11 mm ²/day; (range of 0,04 to 0,22 mm ²/day). Treatment failure was present in 3 patients. Patient 5 with an initial ulcer of 2 mm² by day 12 presented an ulcer of 1.25 mm²; having a re-epithelialization only with autologous serum of 0.06mm² per day; topical acyclovir was added , and the total remission was seen by day 3, with a re-epithelialization of 0.78mm² per day. Patient 4 presented corneal perforation by day 7. In group II we had 6 ameboid and 2 oval ulcers. Monotherapy was successful in 6 patients, the average size of the ulcer was 0,68 mm² (range of 0,2 to 1.65mm²), and remission average was in 7 days, range of 3 to 9 days; and a remission of 0.09mm² per day; range of 0,04 to 0.18mm² . Patient 6 failed initial treatment (ulcer with a 0.65mm², by day 6 was 0.7mm², increasing 0.008mm² per day; autologous serum was added. Remission occurred at day 6 with a re-epithelialization of 0.11mm² per day. Patient 8 presented a perforation by day10 (p= 0.58).

Conclusions:: Autologous serum helps in the re-epithelialization of the ocular surface. Treatment failure was greater in group I than in group II . Autologous serum had good results in defects < 2mm ². Autologous serum did not show greater effectiveness than acyclovir, but could be used as adjuvant therapy.

Clinical Trial:: Comité de Etica de la FHNSL

Keywords: cornea: epithelium • herpes simplex virus • antiviral drugs