Overcoming Resistance: A Comprehensive Review and Treatment Approach for Acyclovir-Resistant Herpes Simplex Keratitis

To comprehensively review the treatment approach for acyclovir (ACV)-resistant herpes simplex keratitis (HSK).

We thoroughly searched Web of Science, PubMed, and Scopus for relevant keywords and conducted this narrative review which explores the diagnosis of ACV-resistant HSK, and discusses alternative treatment strategies, reports previous cases.

Treatment strategies for ACV-resistant HSK include increasing ACV doses, switching to oral valacyclovir (VACV), and using topical antivirals such as foscarnet (FOS), ganciclovir (GCV), trifluridine, and cidofovir. Debridement of lesions and emerging antiviral agents are also considered. The review emphasizes the importance of diagnosing cytomegalovirus in ACV-resistant cases and explores new treatments like helicase primase inhibitors and BX795. Insights from the authors' clinical experience contribute to understanding ACV-resistant HSK and provide valuable guidance for clinicians managing this condition.

HSK is a leading cause of ocular complications in HSV infections, potentially causing visual impairment. ACV has been the primary treatment, but rising ACV resistance necessitates alternative strategies. Options include increased ACV doses, oral VACV, topical FOS, GCV, interferon, and lesion debridement. Clinicians should also explore emerging treatments for ACV-resistant HSK.