TOPICAL CYCLOSPORINE AS AN ADJUNCT TO TOPICAL ACYCLOVIR TREATMENT IN HERPETIC STROMAL KERATITIS

Background/Aims: Immunological factors play an important role in the d evelopment of herpetic stromal keratitis. T lymphocytes are the princi pal cells involved in this immunologic reaction. We therefore investig ated the efficacy and safety of topical cyclosporin A 2% solution in h erpetic stromal keratitis. Methods: Ten patients with herpetic stromal keratitis received topical cyclosporin A 2% 4 times daily for 2 month s. Acyclovir 3% ointment 5 times daily and cycloplegic eyedrops 2 time s daily were used in conjunction with cyclosporin ii solution in the 1 st month of treatment. Topical steroids were not used. The patients we re followed for 6-9 months. Treatment efficacy was evaluated according to two parameters: resolution of stromal infiltrates and neovasculari zation and increase in visual acuity by two or more Snellen lines. Ser um cyclosporin A levels were measured with high-performance liquid chr omatography. Results: In all the patients, the stromal infiltration re solved completely after 2 months of treatment. Visual acuity increased by two or more Snellen lines in 8 out of 10 patients. In the remainin g 2 cases, stromal scarring that was present before cyclosporin A trea tment prevented vision increase. There were no serious complications f rom the cyclosporin treatment but 4 cases complained of severe burning upon instillation of the drug. This complication was temporary and di d not result in discontinuance of the drug. Serum levels of the drug w ere always below toxicity levels. Conclusion: While this is a noncontr olled study, our results show that topical cyclosporin can be a valuab le adjunct to acyclovir treatment in herpetic stromal keratitis. Use o f topical cyclosporin in dendritic herpetic ulcers and necrotic stroma l keratitis has not been investigated in this study.