Efficacy of low-dose and long-term oral acyclovir therapy after penetrating keratoplasty for herpes simplex heratitis

Akova, Yonca A.; Onat, Mustafa; Duman, Sunay

doi:10.1076/ocii.7.1.51.8113

Cited by 29 publications

(24 citation statements)

References 5 publications

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“…15 Although evidence on the optimal duration and dosage for antiviral prophylaxis is divided in the literature, long-term prophylactic oral acyclovir significantly decreased the recurrence of herpes simplex keratitis following keratoplasty 16 and reduces corneal graft failure in patients with a history of recurrent herpes simplex keratitis. [17][18][19][20] It is therefore surprising that antiviral prophylaxis was prescribed by fewer than half of the participants in this survey.…”

Section: Discussionmentioning

confidence: 99%

Opinions on Risk Factors and Management of Corneal Graft Rejection in the United Kingdom

Koay¹,

Lee²,

Figueiredo³

2005

Cornea

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Section: Discussionmentioning

confidence: 99%

Opinions on Risk Factors and Management of Corneal Graft Rejection in the United Kingdom

Koay¹,

Lee²,

Figueiredo³

2005

Cornea

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“…Corneal transplantation for corneal scarring induced by HSV can restore vision and induce rapid recovery. Recurrence of herpetic keratitis in the transplanted graft, however, may lead to corneal graft rejection and a decrease in vision due to recurrence of HSV in the transplanted cornea [37][38][39][40][41][42]. It is therefore suggested that long-term prophylaxis with topical ganciclovir gel or acyclovir ointment might help to prevent recurrence of the disease and subsequent graft rejection.…”

Section: Corneal Transplantation In Patients With Herpetic Keratitismentioning

confidence: 92%

“…5, 6) [43]. The use of topical antiviral prophylaxis may help in the prevention of recurrence of herpetic keratitis in patients with corneal grafts [38,42]. It appears that prophylaxis in patients who have undergone PKP for herpetic disease is essential in the prevention of corneal graft failure.…”

Section: Corneal Transplantation In Patients With Herpetic Keratitismentioning

confidence: 93%

Pharmacologic strategies in the prevention and treatment of corneal transplant rejection

Tabbara

2007

Int Ophthalmol

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Corneal transplantation remains one of the most successful organ transplantation procedures in humans. The unique structure of the cornea, with its absence of blood vessels and corneal lymphatic, allows the survival of corneal allograft. Recent advances in sutures, storage media, microsurgical instrumentation, and new pharmacological strategies have greatly improved the success of corneal transplantation and the prevention of corneal allograft rejection. Our strategies in the management and prevention of corneal graft rejection can modify and improve the survival of corneal allografts. Preoperative evaluation, understanding the risk factors, and management of ocular surface disorders may greatly improve the survival of the corneal transplant. Early recognition of corneal allograft rejection and aggressive treatment may improve the survival of the corneal graft. Furthermore, patients who undergo corneal transplantation should be maintained under close ophthalmic surveillance and patients should be informed to report immediately whenever symptoms of corneal graft rejection occur. The mainstay of therapy is topical corticosteroids. In severe cases, periocular, intravenous, and oral corticosteroids therapy can be rendered. New therapeutic modalities such as cyclosporine, tacrolimus, daclizumab, mycophenolate mofetil, leflunomide, rapamycin, and others may prove to be of help in the prevention and treatment of corneal graft rejection. Early recognition of corneal graft rejection and prompt treatment are mandatory for the successful survival of the corneal allograft.

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“…Reaktivasyonun ve AR'nin en sık görüldüğü ve steroidlerin yoğun olarak kullanıldığı PK sonrası ilk yıl antiviral koruma (oral asiklovir 800 mg /gün) uygulanması önerilmektedir. [20][21][22] Bu olguda da PK sonrası ilk 7 ay profilaktik asiklovir kullanılmıştır. Ancak AR tedavisinde çok daha yoğun uygulanan steroidler de HSV reaktivasyonu ihtimalini arttırır.…”

Section: Discussionunclassified

Herpetik Keratit Skarı Nedeniyle Penetran Keratoplasti Yapılan Olguda Latanoprost Kullanımı Sonrası Görülen Allograft Reaksiyonu

...

2012

Tjo

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ÖzetYirmi yedi yaşında erkek hastanın sağ gözüne herpetik keratite ikincil kornea skarı nedeniyle penetran keratoplasti (PK) uygulandı. Takip sürecinin 14.ayında tedaviye dirençli göz içi basıncı yüksekliği nedeniyle latanoprost başlandı. Tedavinin 15. gününde allograft reaksiyonu (AR) gelişti. Yoğun immunsüpresif tedaviye rağmen, yeterli cevabın alınamaması, steroid tedavisine ikincil herpetik keratoüveiti düşündürdü. Oral antiviral tedavi ile keratik presipitatların dramatik azalması, bu düşünceyi doğruladı. AR tedavisi sonrası 3. ayda greft saydamlığı devam etmektedir. PK yapılan gözlerde inflamasyon, ön kamaranın immun ayrıcalığını bozarak greft başarısını tehlikeye atabilmektedir. Prostaglandin analoglarının kan-aköz bariyeri üzerine etkileri göz önüne alındığında, bu olguda latanoprost kullanımının AR ile ilişkili olabileceği akla gelmektedir. Olguda dikkat çeken bir diğer özellik ise AR tedavisine ikincil olarak herpes simpleks virüs (HSV) reaktivasyonunun izlenmesidir. Bu nedenle, HSV hikayesi olan olgularda AR tedavisi ile beraber oral antiviral profilaksinin verilmesi greft başarısını arttıracaktır. (Turk J Oph thal mol 2012; 42: 150-3) Anah tar Ke li me ler: Allograft reaksiyonu, herpes simpleks virüs, latanoprost, oral asiklovir profilaksisi, penetran keratoplasti Sum maryA 27-year-old male patient with a corneal scar secondary to herpetic keratitis in the right eye underwent penetrating keratoplasty (PK). At the 14 th month of follow-up, latanoprost was started to treat high intraocular pressure which was refractory to treatment. On the 15 th day of latanoprost use, allograft reaction (AR) developed. Insufficient clinical response despite intensive immunosuppressive therapy made us consider the possibility of recurrent herpetic keratouveitis secondary to steroid treatment. The dramatic reduction in the number of keratic precipitates with oral valacyclovir treatment confirmed this diagnosis. The graft remained clear 3 months after the AR treatment. Inflammation in eyes that had undergone PK jeopardizes the graft success by disrupting the immune privilege of anterior chamber. Considering the effects of prostaglandin analogues on blood-aqueous barrier, latanoprost use might have been related to allograft reaction in this case. Another remarkable characteristics of this case was the herpes simplex virus (HSV) reactivation secondary to AR therapy. For this reason, oral acyclovir prophylaxis together with AR therapy would improve graft success in cases with HSV history. (Turk J Oph thal mol 2012; 42: 150-3)

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Efficacy of low-dose and long-term oral acyclovir therapy after penetrating keratoplasty for herpes simplex heratitis

Abstract: Our results suggest that postoperative oral acyclovir therapy is effective in preventing the recurrence of herpetic infection. However, the recurrence may develop after cessation of oral acyclovir therapy, especially in patients who underwent PK for corneal perforation due necrotizing HSK.

Cited by 29 publications

References 5 publications

Opinions on Risk Factors and Management of Corneal Graft Rejection in the United Kingdom

Opinions on Risk Factors and Management of Corneal Graft Rejection in the United Kingdom

Pharmacologic strategies in the prevention and treatment of corneal transplant rejection

Herpetik Keratit Skarı Nedeniyle Penetran Keratoplasti Yapılan Olguda Latanoprost Kullanımı Sonrası Görülen Allograft Reaksiyonu

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