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Herpes Zoster keratitis

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Last updated: February 6th, 2022

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Summary of Evidence

Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, with similar tolerability but simpler dosing schedule for valaciclovir. {Colin J, Prisant O, Cochener B, Lescale O, Rolland B, Hoang-Xuan T. Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus. Ophthalmology. 2000 Aug;107(8):1507-11.}

Evidence

1. Background

1.1 Natural history

Review

2018 Li

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2018
Review

Review of the findings associated with and the management of acute zoster keratitis. {Li JY. Herpes zoster ophthalmicus: acute keratitis. Curr Opin Ophthalmol. 2018 Jul;29(4):328-333.}

Li
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2. Treatment of herpes zoster ophthalmicus

2.1 Antiviral treatment

2.1.1 Valaciclovir vs Aciclovir

Clinical Trial

2000 Colin et.al.

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2000
Clinical Trial

Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, with similar tolerability but simpler dosing schedule for valaciclovir. {Colin J, Prisant O, Cochener B, Lescale O, Rolland B, Hoang-Xuan T. Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus. Ophthalmology. 2000 Aug;107(8):1507-11.}

  • Randomized controlled trial of 110 immunocompetent patients with herpes zoster ophthalmicus treated with valaciclovir or aciclovir.
  • Findings:
    • ocular complications were similar in both groups and included conjunctivitis, superficial keratitis, stromal keratitis and uveitis.
    • Pain duration and severity and outcome of skin lesions were similar between groups
Outcome Valaciclovir Aciclovir
Ocular complication Conjunctivitis 54% 52%
Punctate keratitis 39% 48%
Dendritic keratitis 11% 11%
Stromal keratitis 13% 13%
Uveitis 13% 17%
Pain Complaints of pain after 1 month 25% 31%

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2.1.3 CXL - transepithelial

3. Prophylaxis

3.1 Ocular surgery

Review

2020 Kanclerz & Alio

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2020
Review

Review of the evidence on prophylaxis in the perioperative period in patients having undergone HSK/HZO. {Kanclerz P, Alio JL. Ocular surgery after herpes simplex and herpes zoster keratitis. Int Ophthalmol. 2020 Dec;40(12):3599-3612.}

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References

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