Anterior Segment Herpetic Keratitis
Ganciclovir Ophthalmic Gel in the Treatment of Herpes Simplex Keratitis Penny A Asbell, MD, FACS, MBA
Professor of Ophthalmology, Director of Cornea and Refractive Services, Department of Ophthalmology, Mount Sinai School of Medicine
Abstract
Herpes simplex keratitis (HSK) is the most common form of viral keratitis and is a common cause of ocular morbidity and blindness. HSK is caused by the herpes simplex virus (HSV) and occurs in patients with no previous exposure to HSV typically occurring during childhood, or in patients with latent disease bearing dormant virus in the nerve ganglia or the cornea. HSK initially presents as a cluster of small, clear vesicles in the epithelium that accumulates to form dendritic lesions which can progress to geographic ulcers, whilst further progression of infection deeper into the cornea affects the stroma. Ganciclovir (GCV) was developed for the treatment of acute superficial herpetic keratitis as a replacement for earlier, less effective, or less tolerated antiviral therapy. Studies have found topical GCV gel treatment to be safe and well tolerated with more favorable pharmacokinetics than acyclovir. The recent approval by the US Food and Drug Administration (FDA) for the clinical use of 0.15% GCV gel for treatment of HSK will provide patients and physicians with a more tolerable, convenient, and effective treatment.
Keywords Acyclovir, adenoviral keratoconjunctivitis, ganciclovir, herpes simplex keratitis, ocular herpes, ophthalmic gel
Disclosure: Penny A Asbell, MD, FACS, MBA, has acted as a consultant for Alcon, Aton, Bausch & Lomb, Inspire, Johnson & Johnson, Merck, Pfizer, Santen, and Vistakon Pharma, has received research funding from the National Institutes of Health, Research to Prevent Blindness, the Toni and Martin Sosnoff Fund, Bausch & Lomb, Alcon, and Inspire, and has received educational grants from Santen and Inspire. Acknowledgment: Editorial assistance was provided by Touch Briefings. Received: January 21, 2011 Accepted: March 1, 2011 Citation: US Ophthalmic Review, 2011;4(1):63–8 Correspondence: Penny A Asbell, MD, FACS, MBA, Professor of Ophthalmology, Director of Cornea and Refractive Services, Department of Ophthalmology, Mount Sinai School of Medicine, 1190 Fifth Avenue, New York, New York 10029. E:
penny.asbell@
mssm.edu
Support: The publication of this article was funded by Bausch & Lomb. The views and opinions expressed are those of the author and not necessarily those of Bausch & Lomb.
Herpes Simplex Keratitis—A Significant Burden and Threat to Human Eyesight Herpes simplex keratitis (HSK), caused by the herpes simplex virus (HSV), is the most common form of viral keratitis and is a common cause of ocular morbidity and blindness.1,2
such as recent organ transplant patients or patients with human immunodeficiency virus (HIV).8
HSV type 1 is almost exclusively HSV infection is extremely common in
populations worldwide. It is one of the more common severe infectious agents of the fetal and newborn periods, usually occurring after exposure to the virus during delivery.3
Although infection is usually
acquired in early childhood, increasing age correlates with a significant increase in the percentage of the population that is seropositive.4–6
In
the US, nearly 60% of the population has shown evidence of infection with nearly 20,000 new primary cases of ocular herpes per year.7
Approximately 1% of infected persons develop ocular outbreaks.8 Ocular
disease may be one of two forms—primary disease in patients with no previous exposure to HSV typically occurring during childhood, or latent disease in patients bearing dormant virus in the nerve ganglia or the cornea which can be reactivated by factors such as stress, ultraviolet (UV) radiation, and menstruation.9,10
Recurrent disease is more common,
accounting for 30,000 of the 50,000 cases of HSK diagnosed each year.11,12
Lesions are also common in immunosuppressed individuals, © TOUCH BRIEFINGS 2011
responsible for ocular and orofacial infections whilst HSV type 2 generally causes genital disease. HSV type 2 may infect the eye by means of orofacial contact with genital lesions and is occasionally transmitted to neonates at birth when the mother has a genital HSV type 2 infection.
HSK initially presents as a cluster of small, clear vesicles in the epithelium that accumulate to form dendritic lesions (see Figure 1), occurring in approximately 15% of initial episodes of ocular HSV.13
Left untreated, they
can progress to geographic ulcers, a type of large epithelial defect with fimbriated edges. With progression of infection deeper into the cornea, the stroma may become affected—stromal keratitis represents approximately 2% of primary ocular HSV-1 infections.14
Patients may have latent HSV in the trigeminal ganglion or cornea, and recurrent episodes of ocular disease can increase in incidence over time, leading to an elevated risk of corneal damage and blindness.2,15 Patients with severe corneal damage are candidates for corneal transplantation, but recurrence of HSK in the corneal graft may result in structural damage leading to graft rejection and failure.2,16
Upon 63
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