Acute Herpetic Keratitis: What is the Role for Ganciclovir Ophthalmic Gel?

Abstract

Herpes simplex keratitis (HSK) is a major cause of corneal blindness in the world. Following the primary infection, the virus enters into a latent phase. Recurrent infectious or immune keratitis cause structural damage to the cornea, scarring, and may lead to blindness. Several commercially available topical and oral antiviral drugs for HSK are currently available. However, toxicity and low patient compliance hamper their use in HSK. Further, oral antiviral drugs alone are not always effective in HSK. Thus, there had been a need for safe and effective topical antiviral agents against HSK. Systemic ganciclovir has been in use for the treatment of cytomegalovirus infections. Recently, topical ganciclovir has become available for use in patients with HSK. Ganciclovir 0.15% ophthalmic gel has been shown to be both safe and effective against viruses of the herpes family. Topical ganciclovir ophthalmic gel is well tolerated and does not cause significant toxic effects on the ocular surface. Several multicenter studies have revealed the potential role of ganciclovir ophthalmic gel in the treatment and prophylaxis of epithelial HSK. In this paper, we have reviewed the pharmacology, efficacy, side effects, and the role of ganciclovir ophthalmic gel 0.15% in the treatment of acute herpetic keratitis.

Treatment of Pseudodendrites in Herpes Zoster Ophthalmicus With Topical Ganciclovir 0.15% Gel

“…8,23 The recommended regimen is 0.15% gel 5 times a day in the affected eye until the corneal lesions heal and then tid for 7 days. Few side effects have been reported, including blurred vision (60%), eye irritation (20%), punctate keratitis (5%), and conjunctival hyperemia (5%).…”

“…7 Recently, topical ganciclovir 0.15% ophthalmic gel (Zirgan; Bausch & Lomb, Rochester, NY) has become available in the United States for treatment of herpetic disease. Although very effective for Herpes simplex virus keratitis, 8 we also report the successful use of topical ganciclovir gel in pseudodendritic Herpes zoster keratitis as well.…”

Ganciclovir ophthalmic gel 0.15% for the treatment of acute herpetic keratitis: background, effectiveness, tolerability, safety, and future applications

“…Incidence of HSV keratitis in the US and Europe ranges from 4.1 to 31.5 cases per 100,000 per year, of which 42% comprise new cases and 58% recurrent cases 4,5,13–15. In raw numbers, that represents some 48,000 to 59,000 episodes of ocular herpes diagnosed each year stateside, 20,000 to 24,000 of these being new primary cases 3,4,10,12,14. Across the globe, roughly one million new or recurrent cases of herpes simplex epithelial keratitis occur annually 16.…”

“…After the primary infection, the herpes virus enters a nonreplicating latent stage. It remains dormant indefinitely, typically in the trigeminal nerve ganglion, until such a time that it may reactivate, and then recurs clinically 1,3,7. The virus has been discovered in other spinal ganglia as well 30.…”

“…Children appear susceptible to developing more severe HSV keratitis, including geographic ulcers 2. Repeated occurrences of ulcerative disease as well as chronic stromal keratitis can result in progressive corneal scarring, thinning, and vascularization 3,14. Ultimately, visual acuity can be affected to the point where a patient is in need of corneal transplant.…”