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Venugopal A, Christy J, Raut V, P P, Patwardhan V, V V, Madkaikar A, P M, Meenakshi R, Ramakrishnan R. Viral Keratitis, Surgical Intervention in Viral Keratitis, Challenges in Diagnosis and Treatment of Viral Keratitis, HSV, HZV. Semin Ophthalmol 2024; 39:340-352. [PMID: 38303587 DOI: 10.1080/08820538.2024.2309533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
Viral keratitis is a significant cause of ocular morbidity and visual impairment worldwide. In recent years, there has been a growing understanding of the pathogenesis, clinical manifestations, and diagnostic modalities for viral keratitis. The most common viral pathogens associated with this condition are adenovirus, herpes simplex (HSV), and varicella-zoster virus (VZV). However, emerging viruses such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Vaccinia virus can also cause keratitis. Non-surgical interventions are the mainstay of treatment for viral keratitis. Antiviral agents such as Acyclovir, Ganciclovir, and trifluridine have effectively reduced viral replication and improved clinical outcomes. Additionally, adjunctive measures such as lubrication, corticosteroids, and immunomodulatory agents have alleviated symptoms by reducing inflammation and facilitating tissue repair. Despite these conservative approaches, some cases of viral keratitis may progress to severe forms, leading to corneal scarring, thinning, or perforation. In such instances, surgical intervention becomes necessary to restore corneal integrity and visual function. This review article aims to provide an overview of the current perspectives and surgical interventions in managing viral keratitis. The choice of surgical technique depends on the extent and severity of corneal involvement. As highlighted in this article, on-going research and advancements in surgical interventions hold promise for further improving outcomes in patients with viral keratitis.
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Affiliation(s)
- Anitha Venugopal
- Department of Cornea & Refractive services, Aravind Eye, Hospital and postgraduate institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Josephine Christy
- Department of Cornea & Refractive services, Aravind Eye Hospital, Pondicherry, India
| | - Vaidehi Raut
- Post-Graduate in Ophthalmology Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Preethi P
- Post-Graduate in Ophthalmology Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Veena Patwardhan
- Medical Consultant, Cornea and Refractive Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Veeramma V
- Fellow in Cornea and Refractive surgery, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Aditee Madkaikar
- Department of Cornea & Refractive services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Mangala P
- Department of Cornea & Refractive services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Descemet Membrane Endothelial Keratoplasty in Irreversible Corneal Edema Due to Herpes Simplex Virus Endotheliitis. Cornea 2019; 39:8-12. [DOI: 10.1097/ico.0000000000002135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Basak SK, Basak S. Recurrence of herpes simplex virus endotheliitis in a Descemet membrane endothelial keratoplasty graft: mimicking fungal interface infection. BMJ Case Rep 2019; 12:12/5/e229441. [PMID: 31064790 DOI: 10.1136/bcr-2019-229441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recurrence of herpes simplex virus (HSV) keratitis is a problem of keratoplasty and the prognosis is often poor in spite of oral acyclovir (ACV) prophylaxis. This 64-year-old woman was a known case of recurrent HSV endotheliitis with irreversible corneal oedema in the left eye for 2 years. She underwent Descemet membrane endothelial keratoplasty with intraocular lens implantation under perioperative oral ACV and prednisolone. After 4 weeks, her cornea cleared with the best-corrected vision of 6/9. After 2.5 months, she presented with sudden photophobia and visual loss. An increasing focal endothelial lesion was noticed even after oral ACV. Suspecting fungal interface infection, anterior chamber tap was done for PCR for panfungal and viruses. It was only positive for HSV. Oral ACV was changed to oral valacyclovir. The patient responded dramatically within 2 weeks, and after 12 weeks, the lesion disappeared completely, leaving behind a faint scar with 6/9 p vision. Oral valacyclovir, a prodrug of ACV, may work better than oral ACV.
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Affiliation(s)
- Samar K Basak
- Department of Ophthalmology, Disha Eye Hospitals, Kolkata, India
| | - Soham Basak
- Department of Ophthalmology, Disha Eye Hospitals, Kolkata, India
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Abstract
PURPOSE OF REVIEW To review recent advancements in the management of herpes simplex virus (HSV) epithelial keratitis. RECENT FINDINGS Trifluridine eye drop, acyclovir (ACV) ointment, ganciclovir gel, and oral ACV are still the main therapeutic agents. Cryopreserved amniotic membrane has been recently used as an adjuvant treatment. Resistance to ACV has become a concerning issue. The animal models of HSV vaccine are able to reduce HSV keratitis. New antivirals are under development. SUMMARY Current cases of HSV epithelial keratitis are manageable with available medications, but new advancements are required to decrease disease burden in the future. HSV vaccine can be revolutionary.
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Tsatsos M, MacGregor C, Athanasiadis I, Moschos MM, Hossain P, Anderson D. Herpes simplex virus keratitis: an update of the pathogenesis and current treatment with oral and topical antiviral agents. Clin Exp Ophthalmol 2016; 44:824-837. [PMID: 27273328 DOI: 10.1111/ceo.12785] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/02/2016] [Accepted: 05/25/2016] [Indexed: 01/02/2023]
Abstract
Ophthalmic herpes simplex viral keratitis is responsible for a range of ocular manifestations from superficial epithelial disease to stromal keratitis and endotheliitis. The Herpetic Eye Disease Study has guided the management of herpetic eye disease for almost twenty years, but newer medications such as valacyclovir are now available and are considered to have better bioavailability than acyclovir. In this review, we examine the existing evidence on the pathogenesis of different ophthalmic herpes simplex viral keratitis disease modalities and the role of oral and topically administered antiviral drugs in the treatment of herpes simplex viral keratitis.
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Affiliation(s)
- Michael Tsatsos
- Royal Eye Infirmary, Dorset County Hospital NHS Foundation Trust, Dorchester, UK.,Southampton University Hospitals NHS Foundation Trust, Southampton, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University of Athens, Athens, Greece
| | - Cheryl MacGregor
- Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | | | | | - Parwez Hossain
- Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - David Anderson
- Southampton University Hospitals NHS Foundation Trust, Southampton, UK
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Komoto S, Higaki S, Fukuda M, Shimomura Y. Effects of antiviral medications on herpetic epithelial keratitis in mice. Jpn J Ophthalmol 2015; 59:194-200. [PMID: 25707352 DOI: 10.1007/s10384-015-0375-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/21/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Aciclovir (ACV), valaciclovir (VACV) and famciclovir (FCV) are used for systemic infections caused by herpes virus. In Japan, only topical ACV is permitted for use against herpetic keratitis. We investigated the effectiveness of topical ACV, oral VACV and oral FCV on mouse epithelial herpetic keratitis. METHODS C57/BL76 mice were inoculated with HSV-1 McKrae strain in the cornea. Once infection was confirmed 4 days after inoculation, topical ACV, oral VACV and FCV were started and administered for 5 days. Control groups were given either topical or oral saline. On days 2, 4, 6 and 10 after medication started, tears, eyeballs, and trigeminal ganglia were examined using viral culture and real-time PCR. RESULTS Viral culture of tears detected no HSV in the topical ACV group on day 4 after administration start; with similar results for the oral VACV group on day 4; and the oral FCV group on day 6. Real-time PCR of the eyeballs showed significant decrease of HSV DNA copy number in the topical ACV group on days 4 and 6 compared to the topical saline group. Real-time PCR of the trigeminal ganglia showed significant decrease of HSV DNA copy number in the oral VACV group on days 4 and 6, and in the oral FCV group on day 6 compared to the oral saline group. CONCLUSION We suggest that 5-day administration of topical ACV, oral VACV and oral FCV are effective for mouse epithelial herpetic keratitis and sufficiently decrease HSV amounts in the ocular surface and eyeballs.
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MESH Headings
- 2-Aminopurine/analogs & derivatives
- 2-Aminopurine/therapeutic use
- Acyclovir/analogs & derivatives
- Acyclovir/therapeutic use
- Administration, Oral
- Administration, Topical
- Animals
- Antiviral Agents/therapeutic use
- DNA Copy Number Variations
- DNA, Viral/analysis
- Disease Models, Animal
- Epithelium, Corneal/virology
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/virology
- Famciclovir
- Female
- Herpesvirus 1, Human/isolation & purification
- Keratitis, Herpetic/drug therapy
- Keratitis, Herpetic/virology
- Mice
- Mice, Inbred C57BL
- Real-Time Polymerase Chain Reaction
- Tears/virology
- Trigeminal Nerve/virology
- Valacyclovir
- Valine/analogs & derivatives
- Valine/therapeutic use
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Affiliation(s)
- Shohei Komoto
- Department of Ophthalmology, Kinki University Faculty of Medicine, 377-2 Ono-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Hiraoka T, Yamamoto T, Okamoto F, Oshika T. Changes in functional visual acuity and ocular wavefront aberration after administration of eye ointment. J Ocul Pharmacol Ther 2013; 29:770-5. [PMID: 23808568 DOI: 10.1089/jop.2013.0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the influence of an eye ointment on functional visual acuity (FVA) and ocular wavefront aberration. METHODS In 11 healthy volunteers (6 men and 5 women), visual function parameters, such as FVA, visual maintenance ratios (VMR), and minimal visual acuity (minVA), were assessed by the FVA measurement system before and 2, 5, 10, 20, 30, 40, 50, 60, 90, 120, 180, and 240 min after administration of ofloxacin eye ointment. Ocular aberration was also measured, and the root mean square (RMS) of second-, third-, fourth-, and total higher-order aberrations was determined. The time course of changes in each parameter was statistically analyzed by using repeated-measures analysis of variance and the Dunnett post hoc test, and relationships between visual function and ocular aberration parameters were also analyzed by the Pearson correlation test. RESULTS FVA, VMR, and minVA showed significant deteriorations at 2-, 5-, 10-, and 20 min after administration of eye ointment compared with the baseline values (P<0.05). All components of ocular wavefront aberration such as second-, third-, fourth-, and total higher-order RMS significantly increased at 2- and 5 min after the administration of eye ointment compared with the baseline values (P<0.05). In addition, deteriorations of these visual function parameters were significantly correlated with reduced blink numbers (Pearson's correlation coefficient; r=- 0.76, P=0.017 for FVA, r=0.79, P=0.013 for VMR, and r=-0.62, P=0.040 for minVA), and VMR was significantly related with changes in second-order RMS (r=-0.60, P=0.049). CONCLUSIONS Eye ointment significantly reduced visual function for at least 20 min. Especially, minVA was worse than 0.155 logMAR, which is legally required for driving, for 3 h after the administration. In addition, increases in lower-order aberration and low blink rates were associated with the degradation of visual function.
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Affiliation(s)
- Takahiro Hiraoka
- 1 Department of Ophthalmology, Faculty of Medicine, University of Tsukuba , Ibaraki, Japan
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Thomasy SM, Covert JC, Stanley SD, Maggs DJ. Pharmacokinetics of famciclovir and penciclovir in tears following oral administration of famciclovir to cats: a pilot study. Vet Ophthalmol 2012; 15:299-306. [PMID: 22339892 DOI: 10.1111/j.1463-5224.2011.00984.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To validate a means of collecting tears from cats, develop an assay for quantifying famciclovir and penciclovir in tears, and to assess famciclovir and penciclovir concentrations and pharmacokinetics in the tears of cats being treated orally with famciclovir for suspected herpetic disease. ANIMALS Seven client-owned cats. PROCEDURES Cats were treated orally with a median (range) dose of 40 (39-72) mg of famciclovir/kg three times daily for at least 24 h. At various time points following famciclovir administration, tear samples were collected using Schirmer tear test strips. Tear famciclovir and penciclovir concentrations were measured using liquid chromatography-mass spectrometry, and concentration-time profiles were analyzed noncompartmentally. The relationship between famciclovir dose and tear penciclovir concentration near its maximum was evaluated using least squares linear regression. RESULTS Maximum tear famciclovir concentration of 0.305 μg/mL occurred at 2.64 h; elimination half-life was 2.28 h. Maximum tear penciclovir concentration (0.981 μg/mL) occurred 2.25 h following oral administration of famciclovir; elimination half-life was 2.77 h. A significant positive correlation was noted between famciclovir dose and tear penciclovir concentration at various time points between 0.5 and 3.75 h following drug administration (P = 0.025). Tear penciclovir concentration exceeded the concentration shown to have in vitro efficacy against feline herpesvirus (FHV-1) (0.304 μg/mL) in about half of samples collected. CONCLUSIONS Oral administration of 40 mg of famciclovir/kg to cats resulted in a tear penciclovir concentration-time profile that approximated the plasma penciclovir concentration-time profile and frequently achieved a penciclovir concentration at the ocular surface likely to be effective against FHV-1.
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Affiliation(s)
- Sara M Thomasy
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
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Thomasy SM, Lim CC, Reilly CM, Kass PH, Lappin MR, Maggs DJ. Evaluation of orally administered famciclovir in cats experimentally infected with feline herpesvirus type-1. Am J Vet Res 2011; 72:85-95. [PMID: 21194340 DOI: 10.2460/ajvr.72.1.85] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate orally administered famciclovir for treatment of cats with experimentally induced disease attributable to feline herpesvirus type-1 (FHV-1). ANIMALS 16 nonvaccinated specific-pathogen-free cats. PROCEDURES Cats were treated orally with famciclovir (90 mg/kg; n = 10) or a similar volume of lactose (400 mg; 6) 3 times/d for 21 days. Cats were inoculated with FHV-1 and administered the first treatment dose on day 0. Disease score; weight; results of urinalysis, serum biochemical analysis, and CBC; histologic conjunctivitis score; herpetic DNA shedding; goblet cell density; anti-FHV-1 antibody concentration; and plasma penciclovir concentration were measured. RESULTS On days 4 to 18 following inoculation, disease scores were lower in famciclovir-treated cats than in lactose-treated cats. Lactose-treated cats decreased in weight during the first 7 days after inoculation, but famciclovir-treated cats increased in weight throughout the study. Percentage change in weight was greater in famciclovir-treated cats on days 7 and 14 than in lactose-treated cats. Serum globulin concentration was lower on days 3 through 9, conjunctivitis histologic score was lower on day 14, herpetic DNA was shed less frequently throughout the study, goblet cell density was greater on day 21, and circulating anti-FHV-1 antibody concentration at study end was lower in famciclovir-treated cats, compared with these measurements in lactose-treated cats. Approximate peak plasma penciclovir concentration was 2.0 μg/mL. CONCLUSIONS AND CLINICAL RELEVANCE Famciclovir administration improved outcomes for systemic, ophthalmic, clinicopathologic, virologic, and histologic variables in cats experimentally infected with FHV-1. Adjunctive topical mucinomimetic and antimicrobial treatments may also be necessary.
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Affiliation(s)
- Sara M Thomasy
- K. L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
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Itahashi M, Higaki S, Shimomura Y. Effects of Anti Herpetic Drugs on Mice with Herpetic Epithelial Keratitis After Reactivation of Herpes Simplex Virus Type 1. Semin Ophthalmol 2009; 23:241-7. [DOI: 10.1080/08820530802111291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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