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Maria Cabrera-Aguas, Dana Robaei, Stephanie L Watson; Outcomes of anti-viral therapy in herpes simplex keratitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3650.
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© ARVO (1962-2015); The Authors (2016-present)
The global incidence of herpes simplex keratitis (HSK) has been estimated at around 1.5 million, with 40,000 new cases of unilateral visual impairment or blindness per year. This study reports the outcomes in patients treated for HSK at Sydney Eye Hospital, Sydney, Australia.
A retrospective case review of all patients who received anti-virals for HSK was conducted. Cases were identified from pathology results, pharmacy records, and ICD-10 coding data from 2012 to 2013. Patient demographics and clinical details including initial anti-viral therapy and outcome were collated from the medical records. The visual acuity (VA) was converted to logarithm of the minimum angle of resolution (logMAR). Outcome was determined when the initial anti-viral therapy was stopped or changed and classified as clinically improved or worsened for therapeutic use (indication); and success or failure for prophylaxis.
Three hundred and one eyes of 296 patients were included; mean age 54 years (range 19-94) and 60% male. Epithelial HSK was identified in 47% (n=141), stromal HSK in 38% (n=115) and prophylactic indication in 15% (n=45) of eyes. During follow up, 6% (n=18) eyes were diagnosed as not HSK, 24% (n=71) were lost to follow up and 5% (n=15) were on ongoing therapy. Therefore, 197 eyes were analysed.For epithelial HSK, 94% (90/96) of eyes improved and 6% (6/96) worsened. There was no significant difference in logMAR VA in the improved and worsened groups (0.47 vs 0.42, p=0.1, 0.52 vs 0.77, p=0.3). Adverse events occurred in 17% (16/96) of eyes included ocular toxicity from topical aciclovir (n=4) and secondary bacterial keratitis (n=4).For stromal HSK, 85% (67/75) of eyes improved and 15% (12/75) worsened. There was no significant difference in logMAR VA in the improved and worsened groups (0.69 vs 0.65, p=0.3, 0.9 vs 0.87, p=0.9). 19% (14/75) of eyes had side effects; most commonly corneal perforation (n=6).For the prophylactic group, success was identified in 55% (12/22) and failure in 45 % (10/22) of eyes. There was no significant difference in logMAR VA in the success and failure groups (1.05 vs 0.92, p=0.5, 0.93 vs 1.05, p=0.1). Two eyes (9%) had adverse events, side effects from oral anti-virals (n=1) and endophthalmitis (n=1).
Most therapeutic cases improved clinically and visually, and prophylactic cases were successful with initial anti-viral therapy with a low proportion of adverse events.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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