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

IF 0.9 Q3 OPHTHALMOLOGY

Journal of Current Ophthalmology Pub Date : 2025-09-18 eCollection Date: 2024-10-01 DOI:10.4103/joco.joco_85_24

Arash Mirzaei, Sahel Soltani Shahgoli, Raghuram Kognati, Emine Esra Karaca, Kasra Cheraqpour, Farhaneh Alahyari, Deepak Shukla, Ali R Djalilian, Mohammad Soleimani

{"title":"Overcoming Resistance: A Comprehensive Review and Treatment Approach for Acyclovir-Resistant Herpes Simplex Keratitis.","authors":"Arash Mirzaei, Sahel Soltani Shahgoli, Raghuram Kognati, Emine Esra Karaca, Kasra Cheraqpour, Farhaneh Alahyari, Deepak Shukla, Ali R Djalilian, Mohammad Soleimani","doi":"10.4103/joco.joco_85_24","DOIUrl":null,"url":null,"abstract":"Purpose: To comprehensively review the treatment approach for acyclovir (ACV)-resistant herpes simplex keratitis (HSK).Methods: 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.Results: 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.Conclusions: 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.","PeriodicalId":15423,"journal":{"name":"Journal of Current Ophthalmology","volume":"36 4","pages":"342-347"},"PeriodicalIF":0.9000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487793/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Current Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/joco.joco_85_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

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

Methods: 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.

Results: 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.

Conclusions: 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.

查看原文本刊更多论文

克服耐药性：无环韦耐药单纯疱疹性角膜炎的综合综述及治疗方法。

目的：综述抗阿昔洛韦（ACV）单纯疱疹角膜炎（HSK）的治疗方法。方法：全面检索Web of Science、PubMed、Scopus等相关关键词，探讨acv耐药HSK的诊断，探讨替代治疗策略，报道既往病例。结果：ACV耐药HSK的治疗策略包括增加ACV剂量，改用口服valacyclovir (VACV)，以及使用局部抗病毒药物，如foscarnet （FOS）、更昔洛韦（GCV）、trifluridine和西多福韦。病灶清创和新出现的抗病毒药物也被考虑。本综述强调了在acv耐药病例中诊断巨细胞病毒的重要性，并探讨了解旋酶引物酶抑制剂和BX795等新的治疗方法。作者的临床经验有助于理解acv耐药HSK，并为临床医生管理这种情况提供有价值的指导。结论：HSK是HSV感染中眼部并发症的主要原因，可能导致视力损害。ACV一直是主要的治疗方法，但ACV耐药性的上升需要替代策略。选择包括增加ACV剂量、口服VACV、外用FOS、GCV、干扰素和病灶清创。临床医生还应探索抗acv HSK的新疗法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Current Ophthalmology OPHTHALMOLOGY-

CiteScore

2.50

自引率

6.70%

发文量

审稿时长

8 weeks

期刊介绍： Peer Review under the responsibility of Iranian Society of Ophthalmology Journal of Current Ophthalmology, the official publication of the Iranian Society of Ophthalmology, is a peer-reviewed, open-access, scientific journal that welcomes high quality original articles related to vision science and all fields of ophthalmology. Journal of Current Ophthalmology is the continuum of Iranian Journal of Ophthalmology published since 1969.