Evidence-based treatment of herpes simplex virus keratitis: A systematic review

Scott Guess, Donald U. Stone, James Chodosh

Research output: Contribution to journalArticle

Abstract

Herpes simplex virus (HSV) keratitis is a common cause of ocular and visual morbidity. In this article, we systematically review published randomized clinical trials (RCTs) for HSV epithelial and stromal keratitis in order to establish a rational evidence-based foundation for treatment of these disorders. Article for review were identified in the MEDLINE database from January 1, 1966, to May 30, 2006. Our review criteria stipulated that each study be performed in prospective, randomized, and double-blinded fashion, that it be controlled, and that it rely on specific clinical criteria for diagnosis and outcome. Of articles thus identified in the English language press, 38 articles met our review criteria, 30 for HSV epithelial keratitis and 8 (comprising 7 RCTs) for HSV stromal keratitis. From these studies, we concluded that the best evidence from treatment trials on HSV epithelial keratitis supports the use of topical trifluridine and topical or oral acyclovir, and suggests a possible additional benefit for topical interferon. The best evidence from RCTs for HSV stromal keratitis supports the use of topical corticosteroids given together with a prophylactic antiviral to shorten the duration of active HSV stromal keratitis, and the use of long-term suppressive oral acyclovir therapy to reduce the incidence of recurrent HSV keratitis.

Original languageEnglish (US)
Pages (from-to)240-250
Number of pages11
JournalOcular Surface
Volume5
Issue number3
DOIs
StatePublished - Jul 2007

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Keywords

  • Acyclovir
  • Epithelial keratitis
  • Evidence-based medicine
  • Herpes simplex virus
  • Keratitis
  • Randomized clinical trial
  • Stromal keratitis
  • Trifluridine

ASJC Scopus subject areas

  • Ophthalmology

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