Acyclovir ointment plus topical betamethasone or placebo in first episode disciform keratitis.

Abstract

Thirty patients with first episode disciform keratitis and with no previous steroid exposure were randomly assigned to double blind treatment with 3% acyclovir ointment and 0O1% betamethasone (Betnesol) drops or acyclovir ointment and matching placebo. In the steroid group 14 of the 15 patients healed in a mean time of 21-8 days. In the placebo group eight of the 13 patients healed in a mean time of 34-5 days. The difference in mean healing time between the two groups was significant (p<005). The cumulative rate of healing was also quicker in the steroid group when compared with the placebo group (p<0-001). Other clinical parameters improved more favourably in the combination treatment group. Four patients, two in either group, experienced a mild transient punctate epitheliopathy, but no other serious adverse effects were noted. There has been no significant difference in the recurrence rate between the two groups after a mean follow-up period of approximately 3 years. (BrJ Ophthalmol 1992; 76: 711-713) Acyclovir ophthalmic ointment (3%) used five times daily has been shown to be effective in the treatment of dendritic and geographic keratitis. 12 Therapy with acyclovir has been associated with a low incidence of mild transient adverse effects, namely stinging and punctate epitheliopathy.3The aetiology of disciform keratitis is unclear but has been postulated to be viral in origin with an associated delayed type hypersensitivity reaction to herpes antigen within the stroma or endothelium." A combination of antiviral and steroid would seem to be the optimal therapeutic choice. Acyclovir is a good candidate as it is able to penetrate the intact corneal epithelium and stroma, achieving therapeutic levels in the aqueous humour.7 In a previous study we have At presentation the area of involved cornea was measured and was scored as follows; 1=0-25%, 2=25-50%, 3=50-75%, 4=75-100%. The presence of neovascularisation, either superficial or deep and in how many quadrants, was also recorded. Symptoms of pain, photophobia, lacrimation, and grittiness were scored at each visit on a four point scale (0=absent, 1=mild, 2=moderate, 3=severe). The following parameters we-re also assessed at each visit; visual acuity, conjunctival injection, epithelial oedema, stromal oedema, folds in Descemet's membrane, endothelial deposits, anterior chamber flare and cells, intraocular pressure, and corneal thickness using a Haag-Streit pachometer. A record was also made of any adverse effects potentially attributable to the treatment.Patients were randomly assigned to treatment with 3% acyclovir ophthalmic ointment and either 0-1% betamethasone drops or placebo in a double blind manner. Treatment was applied to the affected eye five times daily. The eye was not padded. If patients showed deterioration over 5 days or if the condition remained static for 14 days, they were withdrawn from the study. The keratitis was regarded as healed when the corneal thickness had returned to normal, when epithelial and stromal oedema had regressed,

Penetration of topical and subconjunctival corticosteroids into human aqueous humour and its therapeutic significance

“…In a double-masked randomised trial, Power et al have shown that the cumulative rate of healing was better and quicker in the steroid group (betamethasone 0.1%) when compared with the placebo group 70. However, it is not known how this affects the recurrence rate of active herpetic disease.…”

Herpetik Keratit ve Bakteriyel Keratitlerde Amniyotik Membran Transplantasyonu

“…Hasarı oluşturan asıl neden immün yanıt olduğu için, tedavinin asıl basamağını antiviral ilaçlardan ziyade immünsupresifler (topikal veya sistemik kortikosteroid) oluşturmaktadır. 36,37 Topikal kortikosteroidler keratitin süresini kısaltır ve stromal inflamasyonu azaltır. 37 Ancak topikal kortikosteroidlerin yoğun kullanımı aynı zamanda korneal ülser ve perforasyon riskini arttırarak istenmeyen sonuçlara neden olabilir.…”

Corneal lymphangiogenesis in herpetic stromal keratitis

“…Topical antivirals targeting viral replication and corticosteroids targeting immune-mediated mechanisms are standard treatments for HSK, 10; 26; 27; 114 but have associated risks. For example, corticosteroid use is associated with increased risks of developing glaucoma and cataracts.…”