Acyclovir and Idoxiuridine Treatment of Herpes Simplex Keratitis — A Double Blind Clinical Study

Abstract

38 patients with herpes simplex keratitis were treated in double blind clinical trial. 18 patients (10 with pure epithelial and 8 with accompanying stromal affection) were treated with 3% acyclovir (ACV) eye ointment, and 20 patients (10 with pure epithelial and 10 with accompanying stromal affection) were treated with 0.5% idoxiuridine (IDU). The cure rate was 94% in the ACV group compared to 70% in the IDU group. This was significantly higher in the ACV group. Only minor adverse reactions were recorded.

Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis

“…Sixty-three trials enrolled patients with dendritic epithelial keratitis, including two trials that may have also enrolled other types of HSV epithelial keratitis (Chen 2008; Yang 2000); 38 trials enrolled participants with either dendritic or geographic epithelial keratitis (Blake 1977; Carmassi 1993; Colin 1981; Colin 1984; Colin 1997a; Colin 1997b; Colin 2007a; Colin 2007b; Coster 1976; Coster 1980; Daniel 1972; de Koning 1983; Denis 1983; Fulhorst 1972; Genée 1987; Guerra 1979; Haut 1983; Hoang-Xuan 1984; Huang 2008a; Jackson 1984; Kitano 1985; Laibson 1964; Li 2008; Markham 1977; Maychuk 1988; McCulley 1982; McGill 1974; Patterson 1967a; Pavan-Langston 1976; Pavan-Langston 1981; Serifoglu 1987; Sugar 1980; Sundmacher 1984a; Van Bijsterveld 1989; Wellings 1972; Yeakley 1981; Young 1982); two trials were restricted to patients with geographic keratitis (Collum 1985; Coster 1979); and three trials provided insufficient information to ensure that all participants had dendritic epithelial keratitis (Burns 1963; Davidson 1964; Klauber 1982). Of studies that enrolled eyes with either dendritic or geographic epithelial keratitis, 24 trials provided information on the numbers with dendritic epithelial keratitis (1469) and with geographic epithelial keratitis (326), yielding a median dendritic to geographic epithelial keratitis ratio of 5.0:1 (interquartile range, 3.5:1 to 9.5:1).…”

“…Corneal characteristics of HSV epithelial keratitis that may be associated with prolonged healing include a peripheral corneal location (Wilhelmus 1981a) and the presence of stromal inflammation (Altinisik 1987; Daniel 1972; Klauber 1982; Wilhelmus 1981a), possibly due to an inhibitory effect of inflammatory cells on corneal epithelial wound healing (Wagoner 1984). However, other studies did not demonstrate that the presence of stromal keratitis had a consistent impact on healing (Høvding 1989; Jackson 1984).…”

“…Comparative corneal healing rates among placebo, idoxuridine, vidarabine, trifluridine, and acyclovir: overall healing curves estimated from pooled data from 24 studies (Abe 1987; Altinisik 1987; Blake 1977; Colin 1981; Collum 1980; Collum 1985; Coster 1976; Coster 1979; Coster 1980; Denis 1983; Hart 1965; Hoang-Xuan 1984; Høvding 1989; Jackson 1984; Klauber 1982; Kumar 1987; La Lau 1982; Luntz 1963; Markham 1977; McCulley 1982; Van Bijsterveld 1980; Wellings 1972; Yeakley 1981; Young 1982) that enrolled 1168 participants to evaluate placebo control (44 eyes), idoxuridine (278 eyes), vidarabine (262 eyes), trifluridine (201 eyes), and acyclovir (383 eyes). Compared to the healing rate with idoxuridine, the hazard ratios for healing were 1.36 (95% CI 0.81–2.28) for vidarabine, 2.29 (95% CI 1.37–3.83) for trifluridine, and 2.15 (95% CI 1.70–2.72) for acyclovir among included studies.…”

“… 1 Included idoxuridine studies: Altinisik 1987; Blake 1977; Colin 1981; Collum 1980; Kitano 1985; Klauber 1982; Laibson 1977; MacKenzie 1964; Markham 1977; McCulley 1982; Panda 1995; Pavan-Langston 1976; Vannini 1986; Wellings 1972 2 Included vidarabine studies: Blake 1977; Collum 1985; Coster 1976; Coster 1979; Denis 1983; Jackson 1984; Markham 1977; Pavan-Langston 1976; Pavan-Langston 1981; Van Bijsterveld 1980; Yeakley 1981; Young 1982 3 Included trifluridine studies: Behrens-Baumann 1992; Coster 1976; Coster 1979; Hoang-Xuan 1984; Panda 1995; Parlato 1985; Power 1991; Van Bijsterveld 1980; Wellings 1972 (excluding La Lau 1982 because of imprecise assessment) 4 Included acyclovir studies: Altinisik 1987; Carmassi 1993; Colin 1981; Colin 1983; Colin 1984; Colin 1987; Colin 1997a; Colin 1997b; Colin 2007b; Collum 1980; Collum 1985; Collum 1986; Denis 1983; Hoang-Xuan 1984; Huang 2008a; Jackson 1984; Jensen 1982; Kitano 1985; Klauber 1982; McCulley 1982; Panda 1995; Pavan-Langston 1981; Wilhelmus 1981a; Yeakley 1981; Young 1982 (excluding La Lau 1982 because of imprecise assessment) 5 Included brivudine studies: Panda 1995; Power 1991; Van Bijsterveld 1989 6 Included ganciclovir studies: Colin 1997a; Colin 1997b; <...>…”

“… 1 Included idoxuridine studies: Altinisik 1987; Blake 1977; Colin 1981; Collum 1980; Kitano 1985; Klauber 1982; Laibson 1977; MacKenzie 1964; Markham 1977; McCulley 1982; Panda 1995; Pavan-Langston 1976; Vannini 1986; Wellings 1972 …”