Topical cyclosporine: A versus prednisolone in the treatment of herpetic stromal keratitis

Background: Herpetic stromal keratitis (HSK) is an immune-mediated disease due to primary infection with herpes simplex virus (HSV). It is now known about Cyclosporine A (CSA) that it selectively inhibits T-helper cell production of growth factors essential for B cell and cytotoxic T-cell differentiation and proliferation, so that the immune response which is considered the main cause of stromal lesion and opacity will be formed masking the transparent cornea affecting vision of the patients. The aim of our study was to compare between topical CSA ED versus Prednisolone ED in the treatment of HSK. Methods: The study is prospective, randomized, non-invasive and comparative on 30 eyes with HSK. Participants were divided randomly in numeric manner into 2 groups, each group included 15 eyes: Group (A): treated by topical CSA ED 0.4% and Group (B): treated by topical prednisolone acetate 1%. Comparison between both groups regarding effect on visual acuity, stromal haze, corneal edema, duration of healing, complications, HSV recurrence, vascularization and opacity was done. Results: There was no statistically significant difference between both groups in VA before treatment however, it was statistically significant lower in group B after treatment. There was no statistically significant difference between both groups in grade of stromal infiltration before treatment but there was a statistically significant difference after treatment. Duration of healing was statistically significant lower in group B compared to group A Conclusions: According to our study, CSA ED (0.4%) is effective and comparable to corticosteroid in management of HSK. It may be less tolerable and take longer duration of action but it is superior to steroids as regard the effect on corneal opacity. It has the advantage to decrease corneal vascularization as well. Using corticosteroids is associated with complications especially in more complicated cases like thin cornea and epithelial defects. It causes disease recurrence and IOP elevation so CSA ED is recommended to be used in these cases.