{"title":"Antiviral and Anti-Inflammatory Therapeutic Interventions for Treating Herpes Stromal Keratitis: A Systematic Review.","authors":"Xiaole Li, Manav Nayeni, Monali S Malvankar-Mehta","doi":"10.1080/09286586.2023.2213324","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Herpes stromal keratitis (HSK) is an immune-mediated corneal inflammation that occurs after a herpes simplex virus infection. This paper aims to systematically identify and compare interventions for treating HSK and their patient outcomes.</p><p><strong>Methods: </strong>This systematic review followed the PRISMA methodology. Online databases were searched to obtain all relevant papers. Two independent reviewers screened through 168 records. Seven papers were included and used for data extraction. A qualitative analysis was conducted.</p><p><strong>Results: </strong>HSK patients receiving prednisolone phosphate and acyclovir showed a higher treatment success rate and significantly longer time to failure compared to patients receiving only acyclovir (<i>P</i> < .001). No difference in resolution time was found between oral and topical acyclovir. Between groups receiving dexamethasone and flurbiprofen, resolution occurred in 93% and 67% of patients, and BCVA (LogMAR) improved from 1.0 to 0.30 and 0.48, respectively. BCVA improved in both cyclosporine-A (<i>P</i> < .001) and its control (prednisolone) groups (<i>P</i> = .002). A tacrolimus treatment group showed greater improvement in BCVA compared to its control (prednisolone) group (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Corticosteroids and antivirals managed HSK most effectively only when used concurrently. Oral acyclovir showed similar effectiveness to its ointment counterpart, a preferable alternative for easier administration. Corticosteroid use could induce greater therapeutic benefits when tapered in concentration and frequency and administrated for at least 10 weeks. Anti-inflammatory drugs including flurbiprofen, cyclosporine-A, and tacrolimus could be safe and effective for treating HSK. Future long-term follow-up and RCTs could provide insights on the therapeutic benefits of these potential alternatives.</p>","PeriodicalId":19607,"journal":{"name":"Ophthalmic epidemiology","volume":" ","pages":"191-209"},"PeriodicalIF":1.7000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmic epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/09286586.2023.2213324","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/5/15 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Herpes stromal keratitis (HSK) is an immune-mediated corneal inflammation that occurs after a herpes simplex virus infection. This paper aims to systematically identify and compare interventions for treating HSK and their patient outcomes.
Methods: This systematic review followed the PRISMA methodology. Online databases were searched to obtain all relevant papers. Two independent reviewers screened through 168 records. Seven papers were included and used for data extraction. A qualitative analysis was conducted.
Results: HSK patients receiving prednisolone phosphate and acyclovir showed a higher treatment success rate and significantly longer time to failure compared to patients receiving only acyclovir (P < .001). No difference in resolution time was found between oral and topical acyclovir. Between groups receiving dexamethasone and flurbiprofen, resolution occurred in 93% and 67% of patients, and BCVA (LogMAR) improved from 1.0 to 0.30 and 0.48, respectively. BCVA improved in both cyclosporine-A (P < .001) and its control (prednisolone) groups (P = .002). A tacrolimus treatment group showed greater improvement in BCVA compared to its control (prednisolone) group (P < .001).
Conclusion: Corticosteroids and antivirals managed HSK most effectively only when used concurrently. Oral acyclovir showed similar effectiveness to its ointment counterpart, a preferable alternative for easier administration. Corticosteroid use could induce greater therapeutic benefits when tapered in concentration and frequency and administrated for at least 10 weeks. Anti-inflammatory drugs including flurbiprofen, cyclosporine-A, and tacrolimus could be safe and effective for treating HSK. Future long-term follow-up and RCTs could provide insights on the therapeutic benefits of these potential alternatives.
期刊介绍：
Ophthalmic Epidemiology is dedicated to the publication of original research into eye and vision health in the fields of epidemiology, public health and the prevention of blindness. Ophthalmic Epidemiology publishes editorials, original research reports, systematic reviews and meta-analysis articles, brief communications and letters to the editor on all subjects related to ophthalmic epidemiology. A broad range of topics is suitable, such as: evaluating the risk of ocular diseases, general and specific study designs, screening program implementation and evaluation, eye health care access, delivery and outcomes, therapeutic efficacy or effectiveness, disease prognosis and quality of life, cost-benefit analysis, biostatistical theory and risk factor analysis. We are looking to expand our engagement with reports of international interest, including those regarding problems affecting developing countries, although reports from all over the world potentially are suitable. Clinical case reports, small case series (not enough for a cohort analysis) articles and animal research reports are not appropriate for this journal.
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