Herpetic Eye disease

study (HEDS)

Presented by:

Majed Mohammed Al-Obailan, MD

Classification of A/S ocular HSV disease

1.Primary infection:

A. neonatal.

B. primary (childern, adults)

Classification of A/S ocular HSV disease

2.Recurrent infection

A. Blephritis

B. Conjunctivitis

C. Infectious dendritic or geographic epithelial keratitis

D. Sterile corneal trophic ulceeration.

E. Stromal immune keratitis

1 .Interstitial keratitis.

2 .Immune rings

3 .Limbal vasculitis

4 .Disciform keratitis

Disciform keratits

Necrotizing Stromalkeratitis

F. Endotheliitis and trabeculitis

G. Iridocyclitis

Objective:

5 trials to evaluate the role of steroids and antiviral medication in the treatment and prevention of ocular HSV disaese.

1-Effecacy of oral acyclovir in treating stromal keratitis (non-necrotizing

[disciform] and necrotizing) :

10 weeks course of ACV 400 mg 5x/day or placebo, in addition to topical steroid and trifluridine.

No improvement in:

1 -No. of Rx failures.

2 -time to resolution.

3 -6/12 BCVA.

Oral acyclovir is XXXX in stromal keratitis.

2 -Efficacy of topical corticosteroids in treating stromal keratitis:

10-week tapering course of prednisolone phosphate 8x/day or placebo in addition to topical trifluridine (viroptic)

QID X1/52 then gradual taper.

Topiacl steroid1 -reduce the risk of persistance or

progressive stromal keratitis by 68%.

2 -shortened the duration of keratitis.

Topical steroids are beneficial for the Rx of stromal keratitis.

3 -Efficacy of oral acyclovir in treating iridocyclitis:

10-week course of ACV 400 mg 5x/day or placebo, in addition to topical trifluridine.

Trial was stopped due to slow recruitment.

Rx failure occurred in 50% of the ACV group vs 68% in of the placebo group.

Result were not statistically significant but suggest a possible benefit of oral acyclovir for the Rx of iridocyclitis.

4 -efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis:

3-week course of ACV 400 mg 5x/day or placebo, in addition to topical

trifluridine.

Oral acyclovir did not reduce the risk of stromal keratitis or iritis development in patients with epithelial disease.

11% in ACV group vs 10% in placebo group.

It was more common in those with old Hx of stromal keratitis or iritis( 23% vs 9% in those without previous Hx.

In patients with epithelial keratitis, a 3-week course of oral ACV is XXXX in preventing stromal keratitis or iritis.

5 -efficacy of oral acyclovir in preventing recurrent ocular HSV disease:

12-month course of ACV 400 mg BID or placebo and 6/12 observation period for patients with a Hx of ocular HSV within the preceding year.

Oral acyclovir reduce the risk of recurrent ocular disease during the treatment period (19% vs 32%)

Especialy in in stromal keratitis subset(14% vs 28%).

Non-ocular HSV lower in Rx group(19% vs 36%).

No rebound in the rate of the disaese in 6/12.

Oral acyclovir prophylaxis significantly reduces the risk of recurrent of ocular and orofacial HSV disease, especially in pts with previous

stromal keratitis.

6 -Determinants of recurrent HSV keratitis:

Analyzed the placebo group from the prevention acyclovir trial.

In the placebo group of the previous trial, 18% developed epithelial keratitis and 18% developed stromal keratitis.

Previuos epithelial keratitis did not significantly affect the subsequent risk of epithelial keratitis , and previous stromal keratitis significantly increased the subsequent of stromal keratits (10x).

In patients with ocular HSV disease in the previous year, a history of epithelial keratitis is not a risk factor for recurrent epithelial keratitis , but a history of stromal keratitis increases the risk of subsequent stromal keratitis, and this risk is strongly associated with No. of previous episodes.

CONCLOSION

1- Oral acyclovir is XXXX in stromal keratitis.

2 -Topical steroids are beneficial for the Rx of stromal keratitis.

CONCLOSION

3 -Result were not statistically significant but suggest a possible benefit of oral acyclovir for the Rx of iridocyclitis.

4 -In patients with epithelial keratitis, a 3-week course of oral ACV is XXXX in preventing stromal keratitis or iritis.

CONCLOSION

5 -Oral acyclovir prophylaxis significantly reduces the risk of recurrent of ocular and orofacial HSV disease, especially in pts with

previous stromal keratitis.

CONCLOSION

6 -In patients with ocular HSV disease in the previous year, a history of epithelial keratitis is not a risk factor for recurrent epithelial keratitis , but a history of stromal keratitis increases the risk of subsequent stromal keratitis, and this risk is strongly associated with No. of

previous episodes .