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Interventions for herpes simplex virus epithelial keratitis.

K R Wilhelmus¹

¹Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, 6565 Fannin Street, NC-205, Suite NC-304, Houston, TX 77030, USA. kirkw@bcm.tmc.edu

The Cochrane Database of Systematic Reviews

|May 2, 2001

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Topical antiviral agents like vidarabine, trifluridine, and acyclovir effectively treat herpes simplex virus epithelial keratitis, with similar outcomes. Combining antivirals with interferon may accelerate healing for this eye infection.

Area of Science:

Ophthalmology
Virology
Pharmacology

Background:

Dendritic epithelial keratitis, often caused by herpes simplex virus, is a common ocular condition requiring effective acute treatment.
Numerous clinical trials have investigated various antiviral agents and treatment modalities, but a comprehensive systematic review of comparative studies was lacking.

Purpose of the Study:

To systematically review and compare the efficacy of different treatments for dendritic or geographic herpes simplex virus epithelial keratitis.
To evaluate oral and topical ophthalmic antiviral agents, as well as debridement methods.

Main Methods:

A systematic search of multiple databases (Cochrane, MEDLINE, EMBASE) and grey literature was conducted.
Included are comparative clinical trials assessing antiviral agents or debridement in patients with active epithelial keratitis.

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Data extraction and quality assessment were performed, with healing proportions at 7 and 14 days as primary outcomes.

Main Results:

Data from 96 trials involving 4991 participants were analyzed.
Topical vidarabine, trifluridine, and acyclovir showed significantly higher healing rates within one week compared to idoxuridine, with no significant difference among these three agents.
Interferon monotherapy offered a slight benefit, and its combination with debridement was noted; however, insufficient data exist for debridement and other physical methods.

Conclusions:

Available and investigational antiviral agents for herpes simplex virus epithelial keratitis are effective and comparable.
A combination of antiviral nucleosides and interferon may enhance healing speed.
Future research should focus on achieving adequate statistical power and considering lesion characteristics in treatment response analysis.