Clinical efficacy of oral and topical acyclovir in herpes simplex virus stromal necrotizing keratitis Dutt S, Acharya M, Gour A, Sapra N, Chauhan

Clinical efficacy of oral and topical acyclovir in herpes simplex virus stromal necrotizing keratitis Dutt S, Acharya M, Gour A, Sapra N, Chauhan

Herpetic stromal keratitis (SK), a frequent cause of visual impairment, is considered to represent an immune-mediated inflammatory response to persistent herpes simplex virus virions or subcomponents within the corneal stroma. Four weeks after primary corneal infection, mice were vaccinated intraperitoneally with vhs(-) vaccine or control. Neurol. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In the absence of PMN infiltrates, neither complement nor a significant amount of gamma globulin was localized in the corneal stroma. The incidence of stromal disease in the bFGF treated group (2/16 eyes) was significantly lower than in the control group (11/12 eyes) (P=0.0001), when bFGF was administered 2hr or 24hr p.i. Following an initial infection of the cornea of humans with herpes simplex virus type 1 (HSV-1), the virus enters nerve terminals in the corneal epithelium, is transported retrogradely to neuronal cell bodies within the superior cervical and trigeminal ganglia, and then becomes latent [1] and [2].

Results of the third section show that modulating the aryl hydrocarbon receptor signaling by the use of TCDD shifts the balance toward regulatory T cells, mainly by inducing apoptosis on T effectors and generating Tregs, which results in diminished severity of SK. The mean age of presentation was 51.53 years. In the face of this potentially blinding inflammatory attack, the cornea has the ability to reduce inflammation. HSV1 DNA polymerase chain reaction was positive in 70% cases of those tested. After primary infection, HSV-1 becomes latent in trigeminal ganglia. Clinically, microsporidial stromal keratitis could mimic suppurative or non suppurative inflammation and vascularization of the cornea and includes a differential diagnosis of herpes simplex virus keratitis, fungal or bacterial keratitis. We further show that nerve damage is reversible and regulated by CD4+ T cells.

Topical steroids after initial antiviral therapy are safe and decreases inflammation and improve visual recovery. Early initiation of therapy has better outcomes as compared to late presentations. Prospective interventional case series conducted at a tertiary eye care hospital from April 2013 to April 2014. The study was conducted in compliance with Declaration of Helsinki. Ophthalmology 1994; 101: 1883 1895. The cultures were observed daily for the development of characteristic Cytopathic effect (CPE) of HSV (8) under an inverted phase contrast microscope (Nikon Diaphot, Nikon Corporation, Tokyo, Japan). Patients aged more than 18 years with a diagnosis of active HSV NSK were enrolled.
Clinical efficacy of oral and topical acyclovir in herpes simplex virus stromal necrotizing keratitis Dutt S, Acharya M, Gour A, Sapra N, Chauhan

Ulcer measuring more than 2 mm΂ and involving more than one-third of corneal stroma with an overlying epithelial defect were included. Patients were excluded if they had been treated with antiviral therapy and/or topical or systemic steroids within the previous 6 weeks. In control studies, the authors demonstrated that the absence of DC autophagy had limited effects on innate immunity, consistent with previous studies. Pregnant and lactating women and patients with renal insufficiency were also excluded from the study. Patients who had undergone corneal surgery or any ocular surgery in the preceding 6 months were also excluded. The diagnosis of HSV NSK was based on history and clinical findings. The demographic profile, laterality and duration of disease prior to presentation were recorded.

J. The reason for the addition of passive immunization is that this reduced the high incidence of mortality and also prevented acute HSK, which would lead to permanent corneal damage [13]. History of recurrent episodes of keratitis, any exacerbating or precipitating factors, and any associated systemic illness was recorded. The diagnosis of NSK was clinically based on the presence of thinning, ulceration, and dense infiltration of the stroma, accompanied by an overlying epithelial defect with minimal discharge. The specificity of 10B5 was tested using spleen cells that were stimulated with lipopolysaccharide (5 μg/ml for 24 h) or a mouse B7-H1 transfectant of 293 cells. Patient’s symptoms, visual acuity, conjunctival injection, stromal edema, size of infiltration, and severity of corneal thinning were evaluated on every visit. The area of stromal infiltration was measured according to HEDS protocol.

Administration of pooled human serum which is the source of anti-HSV antibodies at the time of ocular infection has been shown to protect mice from death and corneal disease during primary infection, while allowing for the establishment of latency and subsequent reactivation of virus after corneal UV-B exposure. Photo documentation of each case was done. Copyright 2012 The American Society for Investigative Pathology. Though this is a small case series, but reviewing the literature and in the light of these findings, it is possible for us to suggest that in the absence of effective medical therapy it is reasonable to manage these cases surgically. [7] Patients received a 10 weeks regimen of oral acyclovir 400 mg 5 times/day (Acivir, Cipla Ltd, India) and topical acyclovir eye ointment 5 times/day (Acivir, Cipla™) for 2 weeks. Diluted topical prednisolone sodium phosphate eye drops in buffered isotonic aqueous solution (0.125% Predforte™, Allergan, Irvine, CA, USA) was commenced in tapering doses (starting dose of 4 times/day). Primary outcome measure was a response to therapy which was clinically assessed by comparing the size of infiltrate at trial entry and after 2 weeks of systemic and topical antiviral treatment.

Data were analyzed using SPSS software version 17 (IBM, USA). P ≤ 0.05 was considered statistically significant. Secondary outcome measure was improvement in best-corrected visual acuity from baseline to end of 10 weeks. The study population included 137 cases who presented with “first episode” of HSK and 97 had recurrent infection. Scarring with an intact epithelium was considered as a healed keratitis.

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