Topical cyclosporine‐A versus prednisolone for herpetic stromal keratitis: a randomized controlled trial

Peyman, Alireza; Nayebzadeh, Mohamadreza; Peyman, Mohamadreza; Afshari, Natalie A.; Pourazizi, Mohsen

doi:10.1111/aos.13913

Cited by 14 publications

(5 citation statements)

References 25 publications

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“…The findings of these other investigations are similar to those of our own. In comparison with our study, Peyman et al [14] study revealed that CSA has same effect of prednisolone acetate 1% but can be used more in cases that have contraindication for using steroid therapy. This is different than our study as CSA Group has better clearance of stromal haze but in longer duration but Group B has shorter duration of healing but with more complications especially recurrence of the disease.…”

Section: Discussionsupporting

confidence: 64%

Topical cyclosporine: A versus prednisolone in the treatment of herpetic stromal keratitis

Zidan¹,

Nasef²,

Sabry³

et al. 2023

Int. J. Adv. Res. Med.

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Background: Herpetic stromal keratitis (HSK) is an immune-mediated disease due to primary infection with herpes simplex virus (HSV). It is now known about Cyclosporine A (CSA) that it selectively inhibits T-helper cell production of growth factors essential for B cell and cytotoxic T-cell differentiation and proliferation, so that the immune response which is considered the main cause of stromal lesion and opacity will be formed masking the transparent cornea affecting vision of the patients. The aim of our study was to compare between topical CSA ED versus Prednisolone ED in the treatment of HSK. Methods: The study is prospective, randomized, non-invasive and comparative on 30 eyes with HSK. Participants were divided randomly in numeric manner into 2 groups, each group included 15 eyes: Group (A): treated by topical CSA ED 0.4% and Group (B): treated by topical prednisolone acetate 1%. Comparison between both groups regarding effect on visual acuity, stromal haze, corneal edema, duration of healing, complications, HSV recurrence, vascularization and opacity was done. Results: There was no statistically significant difference between both groups in VA before treatment however, it was statistically significant lower in group B after treatment. There was no statistically significant difference between both groups in grade of stromal infiltration before treatment but there was a statistically significant difference after treatment. Duration of healing was statistically significant lower in group B compared to group A Conclusions: According to our study, CSA ED (0.4%) is effective and comparable to corticosteroid in management of HSK. It may be less tolerable and take longer duration of action but it is superior to steroids as regard the effect on corneal opacity. It has the advantage to decrease corneal vascularization as well. Using corticosteroids is associated with complications especially in more complicated cases like thin cornea and epithelial defects. It causes disease recurrence and IOP elevation so CSA ED is recommended to be used in these cases.

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Section: Discussionsupporting

confidence: 64%

Topical cyclosporine: A versus prednisolone in the treatment of herpetic stromal keratitis

Zidan¹,

Nasef²,

Sabry³

et al. 2023

Int. J. Adv. Res. Med.

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“…The first, central, zone covers the annulus over a 2-mm diameter zone, the second covers the 2–6-mm diameter zone, the third covers the 6–10-mm diameter zone, and the last covers the annulus over a 10–12-mm diameter zone. 16–18…”

Section: Methodsmentioning

confidence: 99%

“…The first, central, zone covers the annulus over a 2-mm diameter zone, the second covers the 2-6-mm diameter zone, the third covers the 6-10-mm diameter zone, and the last covers the annulus over a 10-12-mm diameter zone. [16][17][18] All patients had a complete preoperative eye examination, including BCDVA, slit-lamp biomicroscopy, and fundus examination. In addition, Goldman applanation tonometry (GAT) was done before and at each postoperative visit.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Clinical efficacy of Fluorometholone versus Loteprednol eye drops after photorefractive keratectomy: A triple-blinded randomized controlled trial

Razmjoo

Mikaniki

Peyman

et al. 2022

European Journal of Ophthalmology

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Purpose This study aimed to compare the anti-inflammatory efficacy and safety of 0.1% Fluorometholone (FML) versus (vs.) 0.5% Loteprednol etabonate (LE) following photorefractive keratectomy (PRK). Methods A triple-blinded randomized controlled trial was conducted on both eyes of 100 patients with stable refraction who were candidates for PRK. Both eyes in each subject were randomly allocated to the FML or LE groups. The product to be tested was 0.1% FML eye drops packaged in droppers vs. the 0.5% LE sterile ophthalmic suspension (Lotemax®) packaged in identical droppers. The main clinical outcomes were changes in best-corrected distance visual acuity (BCDVA) and corneal optical density. The second clinical outcomes were a change in intraocular pressure (IOP) after the intervention. Results There was no significant difference regarding mean corneal optical density changes between the two groups, one ( P = 0.55) and three months ( P = 0.98) after the intervention. The mean ± SD BCDVA after one month of the intervention was 0.79 ± 0.11 and 0.84 ± 0.11 in LE and FML groups, retrospectively ( P = 0.02). There was no significant difference regarding mean BCDVA between the two groups three months after intervention ( P = 0.21). The IOP showed no significant difference between the two groups after one ( P = 0.18) and three months ( P = 0.53) of the intervention. Conclusions The results of this clinical trial demonstrate that LE and FML treatment was effective with no clinically meaningful effect on IOP following a short course of treatment.

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“…Resistance to acyclovir occurs due to extended use[ 171 ], and mutation in the viral thymidylate kinase and DNA polymerase which decreases enzyme affinity for its substrate[ 172 - 174 ]. Topical cyclosporine drops and prednisolone acetate drops are statistically similar in potency for stemming inflammation and preventing scar development[ 175 ].…”

Section: Antiviral Therapy For Herpes Simplex Keratitis: Efficacy And...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

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Topical cyclosporine‐A versus prednisolone for herpetic stromal keratitis: a randomized controlled trial

Cited by 14 publications

References 25 publications

Topical cyclosporine: A versus prednisolone in the treatment of herpetic stromal keratitis

Topical cyclosporine: A versus prednisolone in the treatment of herpetic stromal keratitis

Clinical efficacy of Fluorometholone versus Loteprednol eye drops after photorefractive keratectomy: A triple-blinded randomized controlled trial

Herpes simplex keratitis: A brief clinical overview

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