A CONTROLLED TRIAL OF ORAL ACYCLOVIR FOR THE PREVENTION OF STROMAL KERATITIS OR IRITIS IN PATIENTS WITH HERPES-SIMPLEX VIRUS EPITHELIAL KERATITIS - THE EPITHELIAL KERATITIS TRIAL
Ba. Barron et al., A CONTROLLED TRIAL OF ORAL ACYCLOVIR FOR THE PREVENTION OF STROMAL KERATITIS OR IRITIS IN PATIENTS WITH HERPES-SIMPLEX VIRUS EPITHELIAL KERATITIS - THE EPITHELIAL KERATITIS TRIAL, Archives of ophthalmology, 115(6), 1997, pp. 703-712
Objective: To evaluate the efficacy of oral acyclovir in preventing st
romal keratitis or iritis in patients with epithelial keratitis caused
by herpes simplex virus (HSV). Methods: Patients with HSV epithelial
keratitis of 1-week or less duration were treated with topical triflur
idine and were randomly assigned to receive a 3-week course of oral ac
yclovir, 400 mg 5 times a day (hereafter referred to as the acyclovir
group), or placebo (hereafter referred to as the placebo group). The d
evelopment of HSV stromal keratitis or iritis was assessed during 12 m
onths of follow-up. Results: Stromal keratitis or iritis developed in
17 (11%) of the 153 patients in the acyclovir group and in 14 (10%) of
the 134 patients in the placebo group, Compared with the placebo grou
p, the adjusted rate ratio for the development of stromal keratitis or
iritis in the acyclovir group was 1.16 (95% confidence interval, 0.56
-2.43). The development of stromal keratitis or iritis was more freque
nt in patients with a history of HSV stromal keratitis or iritis than
in those without such a history (23% vs 9%; P = .01). Conclusions: For
patients with HSV epithelial keratitis treated with topical triflurid
ine, no apparent benefit of a 3-week course of oral acyclovir in preve
nting HSV stromal keratitis or iritis was seen during the subsequent y
ear. The 1-year rate of development of stromal keratitis or iritis was
lower than previously reported in the literature, except in patients
with a history of HSV stromal keratitis or iritis.