Aims-To compare the eYcacy and safety of famciclovir with aciclovir for the treatment of ophthalmic zoster. Methods-Randomised, double masked, aciclovir controlled, parallel group in 87 centres worldwide including 454 patients with ophthalmic zoster of trigeminal nerve (V 1 ) comprised the intent to treat population. Oral famciclovir 500 mg three times daily or oral aciclovir 800 mg five times daily for 7 days. Assessments included day 0 (screening), days 3 and 7 (during treatment), days 10, 14, 21, 28 and monthly thereafter, up to 6 months (follow up). Proportion of patients who experienced ocular manifestations, severe manifestations and non-severe manifestations; loss of visual acuity was the main outcome measure. Results-The percentage of patients who experienced one or more ocular manifestations was similar for famciclovir (142/ 245, 58.0%) and aciclovir (114/196, 58.2%) recipients, with no significant diVerence between groups (OR 0.99; 95% CI 0.68, 1.45). The percentage of patients who experienced severe and non-severe manifestations was similar between groups, with no significant diVerence. The prevalence of individual ocular manifestations was comparable between groups. There was no significant diVerence between groups for visual acuity loss. Conclusion-Famciclovir 500 mg three times daily was well tolerated and demonstrated eYcacy similar to aciclovir 800 mg five times daily. (Br J Ophthalmol 2001;85:576-581) In 50%-72% of patients with ophthalmic herpes zoster (HZO), involvement of the ocular structures leads to ocular manifestations ranging from self limited processes to chronic ocular inflammation or neuropathy which may lead to visual loss.1-3 The mechanism of ocular manifestations is thought to include active viral replication within the eye and ophthalmic trigeminal nerve, followed by vascular and neural inflammation and damage.Aciclovir treatment for HZO has been shown to be beneficial to patients and is currently the standard of care among health practitioners. [4][5][6] Oral aciclovir at doses of 600-800 mg five times daily for 10 days significantly reduced the acute signs and symptoms of the disease and the incidence of common ocular manifestations such as dendriform keratopathy, uveitis, and stromal keratitis.7 8 However, aciclovir has poor and variable bioavailability requiring high frequency dosing regimens which can lead to diYculties with compliance. Famciclovir is the oral form of penciclovir, a nucleoside analogue which shares the same antiviral spectrum as aciclovir for herpes viruses and has similar potency and selectivity. The oral bioavailability of penciclovir is 77% following administration of famciclovir, 11 significantly higher than the bioavailability of aciclovir (10%-20%).12 In addition, the intracellular half life of penciclovir triphosphate is significantly longer than that of aciclovir triphosphate in cells infected with varicella zoster virus in vitro (1-11 hours for penciclovir triphosphate compared with <1 hour for aciclovir triphosphate). 13Famciclovir is cu...

Acetazolamide alters the sensitivity of one or more cone populations, probably the carbonic anhydrase-containing cones. The sensitivity loss is reversible and does not appear to be clinically significant. However, the results suggest that patients administered acetazolamide should be excluded from studies which compare the color vision of glaucomatous patients to that of normals.

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