Stromal herpes simplex keratitis with dry eye disease now reduced recurrence through topical cyclosporin and punctual occlusion treatment

21931Two adjunctive treatments for stromal herpes simplex keratitis combined with dry eye disease reduced recurrences by similar amounts, researchers said.

Action Points

  • Explain to interested patients that herpes simplex is the most common cause of corneal blindness and blindness resulting from infection in the U.S. and other developed countries.
  • Note that this study evaluated different therapies aimed at adjunctive treatment for stromal herpes simplex keratitis combined with dry eye disease and found they were essentially equivalent.

In a retrospective analysis, both topical cyclosporine 0.05% and punctual occlusion by thermal cautery significantly reduced the number and duration of recurrences, according to John Sheppard, MD, of Virginia Eye Consultants in Norfolk, Va., and colleagues.

In patients already treated with punctal occlusion — blocking some of the tear ducts — cyclosporine therapy further reduced the number and duration of recurrences, Dr. Sheppard and colleagues said in the July issue of Archives of Ophthalmology.

The findings come from a nonrandomized, single-center, retrospective, comparative analysis of 42 patients with unilateral herpes simplex keratitis and dry eye disease, Dr. Sheppard and colleagues said.

Of the patients, 22 were treated with punctal occlusion and 10 were given a topical cyclosporine ophthalmic emulsion twice a day in an off-label use. The remaining 10 patients had previously undergone punctal occlusion and had cyclosporine ophthalmic emulsion added.

All patients continued the use of oral acyclovir (Zovirax) or valacyclovir (Valtrex) hydrochloride as well as topical steroids.

The frequency and duration of herpes recurrences were monitored for a year, and compared with rates in the year before treatment was started.

The researchers found:

  • In the year before treatment, those who got punctal occlusion had on average 2.1 recurrences per year, which was significantly reduced (at P=0.01) to 0.45 after treatment.
  • In the year before therapy started, those who got cyclosporine had 1.8 recurrences a year on average, reduced significantly (at P=0.02) to 0.43.
  • In the patients previously treated with punctual occlusion, adding cyclosporine reduced annual recurrences to 0.40 from 0.58, which was significant at P=0.05.

Punctal occlusion reduced the average duration of recurrences to 2.4 months per recurrence from 3.4 months. Multiplying those values by the number of recurrences per year gave an annual recurrence duration of 7.1 months per year before treatment and 1.1 months per year afterward.

Cyclosporine reduced recurrences to 2.5 months from 3.2, yielding an average recurrence duration of 5.8 months per year before treatment and 1.1 months per year afterward.

Patients who had thermal cautery prior followed by cyclosporine had an average duration of 2.2 months per recurrence before treatment, which decreased to 2.0 months when the drug was added. The figures yielded an average recurrence duration of 1.3 months per year before treatment and 0.8 months per year afterward.

The study was limited by its nonrandomized retrospective design, the researchers said, as well as the lack of blinding.

Also, the patients in the study had both stromal herpes simplex keratitis and dry eye disease, making it difficult to draw conclusions about the effect of either treatment on herpes simplex keratitis alone.

Nonetheless, the results "support the hypothesis that cautery and topical cyclosporine independently and concomitantly decrease HSK recurrences," Dr. Sheppard and colleagues concluded.

Source: MedPage Today


Leave a Reply

Protected by Comment Guard Pro