Viral anterior uveitis

Babu, Kalpana; Konana, Vinaya Kumar; Ganesh, Sudha K; Patnaik, Gazal; Chan, Nicole Shu Wen; Chee, Soon-Phaik; Sobolewska, Bianka; Zierhut, Manfred

doi:10.4103/ijo.ijo_928_20

Cited by 48 publications

(40 citation statements)

References 101 publications

(48 reference statements)

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“…Therefore, currently, the treatment of HSV and VZV anterior uveitis may be based on individual experiences and limited literature, largely due to weak clinical trial literature in this regard. Since VZV anterior uveitis is traditionally regarded to be more severe, antiviral therapy is routinely recommended in addition to anti-inflammatory therapy (28). In HSV anterior uveitis, further research is needed in clearly defining the role of antiviral therapy as observed from our meta-analysis.…”

Section: Discussionmentioning

confidence: 96%

Antiviral Therapy for Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV)-Induced Anterior Uveitis: A Systematic Review and Meta-Analysis

et al. 2021

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Topic: Herpes simplex virus (HSV) and varicella zoster virus (VZV) are the most common ocular pathogens associated with infectious anterior uveitis. Currently, there are a number of antiviral agents administered to treat viral anterior uveitis (VAU). However, there is no consensus or guidelines about the most appropriate approach leading for the best treatment outcomes with fewer ocular complications.Clinical Relevance: To perform a systematic review and meta-analysis of the efficacy of different antiviral therapies in the management of anterior uveitis secondary to HSV and VZV.Methods: We searched PubMed, Web of Science, CINAHL, OVID, and Embase up to January 2020. Randomized trials, non-randomized intervention studies, controlled before and after studies and observational studies assessing the effect of oral and or topical treatments for VAU were considered. Data extraction and analysis with evaluation of the risk of bias in the included trials were performed.Results: Oral acyclovir demonstrated a statistically significant good treatment outcome in the management of VZV anterior uveitis (vs. placebo) (OR 0.26, 95% CI 0.11–0.59), but did not have similar effect in HSV anterior uveitis (OR 0.47, 95% CI 0.15–1.50). In the treatment of VZV anterior uveitis, there was significant superiority of oral acyclovir−7 day course—over topical acyclovir (OR 4.17, 95% CI 1.28–13.52). Whereas, there was no significant superiority of one of the following treatment regimens over the others: topical acyclovir over topical corticosteroids (OR 1.86, 95% CI 0.67–5.17), and oral acyclovir−7 day course—over oral acyclovir−14 day course—(OR 0.21, 95% CI 0.01–4.50) or oral valaciclovir (OR 1.40, 95% CI 0.48–4.07).Conclusion: Treatment of HSV and VZV anterior uveitis is currently based on individual experiences and limited literature, largely due to weak clinical trial evidence in this regard. Our results highlight the existence of a substantial gap in our evidence base. This finding might contribute to future research studies to ascertain the role of different antiviral therapies in the treatment of VAU.Systematic Review Registration: PROSPERO registration number: CRD420202 00404.

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Section: Discussionmentioning

confidence: 96%

Antiviral Therapy for Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV)-Induced Anterior Uveitis: A Systematic Review and Meta-Analysis

et al. 2021

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“…Tugal-Tutkun et al [8] did not find any hyphemia in 111 cases of herpes zoster induced anterior uveitis; however, they reported distorted pupil, posterior synechiae, elevated IOP, sectoial iris atrophy in these patients. In cases of herpes zoster uveitis with hyphema, it is widely believed that the presenting hyphema is caused by occlusive vasculitis to the iris leading to ischemia and bleeding into anterior chamber [2], [5], [6]. Severe iris atrophy seen after resolution of the hyphema suggests the possibility of severe inflammation that may have caused the obstruction of iris vessels.…”

Section: Discussionmentioning

confidence: 99%

Herpes Zoster Anterior Uveitis with Hyphaema

Arvinth

Zahari²,

Reddy

2021

EJMED

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Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.

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“…Valganciclovir is used for CMV-induced infections. [26][27][28] Topical corticosteroid is the first choice of medication for noninfectious anterior uveitis. 1 to 2 drops of prednisolone acetate ophthalmic 1% solution or suspension can be prescribed 2 to 4 times daily.…”

Section: Treatment and The Role Of Primary Care Providersmentioning

confidence: 99%