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Recurrence rate of herpetic uveitis in patients on long-term oral acyclovir
A Rodriguez1, W J Power, R A Neves
1Immunology & Uveitis Service, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, USA.
Insights
Long-term oral acyclovir significantly reduced herpetic uveitis (HU) recurrence. Prophylactic acyclovir therapy prevented recurrences, unlike in patients receiving no treatment, thus reducing severe ocular complications.
Area of Science:
- Ophthalmology
- Virology
- Immunology
Background:
- Herpetic uveitis (HU) is a serious ocular disease characterized by recurrent inflammation.
- Recurrences of HU can lead to severe ocular complications, including blindness.
- Previous studies on prophylactic treatment for HU have faced challenges in patient recruitment for randomized trials.
Purpose of the Study:
- To evaluate the recurrence rate of herpetic uveitis (HU) in patients treated prophylactically with long-term systemic acyclovir.
- To compare the recurrence rate of HU in patients on prophylactic acyclovir with those receiving no prophylactic therapy.
Main Methods:
- A retrospective study comparing two groups of patients diagnosed with herpetic uveitis.
- Group A (13 patients) received prophylactic long-term systemic acyclovir (600-800 mg/day).
- Group B (7 patients) received no prophylactic therapy. Both groups were followed for at least 8 months.
Main Results:
- Only one patient in Group A experienced a single recurrence while on prophylactic acyclovir; two others recurred after dose reduction.
- Group B experienced 16 recurrences, with the initial recurrence occurring within an average of 4.3 months after cessation of therapy.
- A significant difference (p < 0.05) was observed in the mean recurrence-free interval between Group A (24.6 months) and Group B (3.4 months).
Conclusions:
- Long-term oral acyclovir prophylaxis appears beneficial in preventing herpetic uveitis recurrences.
- Prophylactic acyclovir may reduce the risk of severe ocular complications associated with recurrent HU.
- Further research, potentially through a randomized controlled trial, is needed to confirm these findings, despite previous recruitment challenges.
Abstract:
We examined the recurrence rate of herpetic uveitis (HU) in 13 patients (group A) treated prophylactically with long-term systemic acyclovir (600-800 mg/day) and compared it with that of 7 patients with no prophylactic therapy (group B). HU was diagnosed on the basis of a history of dendritic or disciform keratitis accompanied by iridocyclitis and iris atrophy. The study population consisted of 12 men and 8 women with a mean age at onset of uveitis of 52.9 years (range 19-78 years). All patients were followed for at least 8 months. The mean follow-up time of patients on long-term oral acyclovir was 26.0 months. In this group, only one patient experienced a single recurrent episode of uveitis while on 600-800 mg/day of acyclovir therapy; two additional patients had recurrence of HU within 16.2 months after the acyclovir dose was tapered below 600 mg/day. In striking contrast, 16 recurrences occurred in the 7 patients of group B (p < 0.05). Of these, the initial recurrence occurred within an average of 4.3 months following cessation of therapy. There was a significant difference (p < 0.05) in the mean recurrence-free interval between patients in group A (24.6 months) and those in group B (3.4 months). Herpetic uveitis is a serious ocular disease in which recurrence of inflammation results in severe ocular complications. The long-term use of oral acyclovir may be of benefit in the prevention of recurrences, and hence may reduce the blinding complications of this disease. Efforts at completing a randomized, placebo-controlled trial on this matter by the Herpes Epithelial Disease Study Group were unsuccessful due to insufficient patient recruitment.