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G.W. Bean, G. Reardon; Association Between Herpes Simplex Keratitis and Topical Ocular Hypotensive Therapy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4396.
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Purpose: Herpes simplex keratitis (HSK), the most common infectious cause of blindness in the US, is an inflammatory condition of the cornea that occurs subsequent to infection with the herpes simplex virus. Case reports have suggested that some topical ocular hypotensive agents may be associated with exacerbation and or reactivation of HSK. We evaluated whether use of particular topical hypotensive therapies is associated with HSK. Methods: This population-based, retrospective cohort study used the Protocare Sciences claims database, which includes prescription and medical claims data from multiple managed care organizations with approximately 3 million enrollees. The study period was 9/1/96-6/30/02. HSK patients were identified as those who either had a medical claim with an ICD code for the condition (ICD=0544, 0544.0-.4, 0544.9) or had a pharmacy claim for vidarabine or trifluridine ophthalmic solution. For each patient with an HSK event, we identified the topical hypotensive agent most recently dispensed prior to, but not preceding by fewer than seven days, the HSK event. Patients dispensed >1 topical hypotensive on the most recent dispensing date were excluded from analyses. For each product, the number of HSK events and the total number of patients receiving the agent (patient-drug combinations) were tabulated. Results: In the 192,840 patients taking IOP-lowering medications, 219 HSK events were identified, producing an overall HSK event rate of 0.11%. The most commonly used drugs were brimonidine (n=25,657 patients), dorzolamide (n=16,471), latanoprost (n=39,174), and timolol (n=45,057). HSK event rates were 0.09% for brimonidine, 0.10% for dorzolamide, 0.11% for latanoprost, and 0.16% for timolol. No significant association was found between HSK and these four products (Chi-square, p=.057). Conclusions: Rates of HSK were low and similar in patients treated with brimonidine, dorzolamide, latanoprost, and timolol. No association was found between use of these four most commonly dispensed ocular hypotensive agents and the incidence of HSK.
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