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K.E. Taba, M.A. Malecha, S. Schuman; Use of Loteprednol to Control Immune Stromal Keratitis Secondary to Herpes Simplex Virus . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4759.
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Purpose: We believe the use of a topical steroid - loteprednol to treat herpes simplex keratitis (HSV) has not been reported. The presumed advantages of loteprednol would be a low risk of intraocular pressure elevation and a low risk of cataract formation. We report the efficacy of loteprednol in controlling immune stromal keratitis (ISK) secondary to HSV in a group of patients. Methods: We retrospectively reviewed the records of all patients with ISK secondary to HSV treated with loteprednol in the University of Tennessee Department of Ophthalmology between August 2000 and August 2002 for duration of treatment, number of recurrences of ISK, final visual acuity, and side effects of the therapy. Results: Seven patients diagnosed with ISK secondary to HSV were treated with either loteprednol 0.5% or loteprednol 0.2%, dosed from 1 to 4 times daily. Oral acyclovir was prescribed along with loteprednol in 6 out of 7 cases. The mean age of the patients was 32 years (range, 5-60 years). The mean follow-up after beginning the therapy with loteprednol was 10 months (range, 6-20 months). Four patients experienced a recurrence of ISK while on loteprednol which resolved in all cases with an increase in dosage of loteprednol. No elevations of intraocular pressure were observed with loteprednol except in one patient who had a concurrent diagnosis of primary open angle glaucoma. One patient developed an infectious epithelial keratitis secondary to HSV while on loteprednol which necessitated discontinuation of the loteprednol. None of the patients developed a cataract while on loteprednol. The mean final visual acuity was 20/30 and was unchanged from the mean initial visual acuity. Conclusions: Loteprednol is an effective treatment of ISK secondary to HSV. Use of loteprednol in ISK is associated with a low incidence of side effects, such as elevations in intraocular pressure, formation of cataracts, or reactivation of infectious epithelial keratitis.
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