Antiviral and Anti-Inflammatory Therapeutic Interventions for Treating Herpes Stromal Keratitis: A Systematic Review

医学 泼尼松龙 角膜炎 氟比洛芬 他克莫司 地塞米松 皮肤病科 皮质类固醇 内科学 外科 药理学 移植
作者
Xiaole Li,Manav Nayeni,Monali S. Malvankar‐Mehta
出处
期刊:Ophthalmic Epidemiology [Taylor & Francis]
卷期号:31 (3): 191-209 被引量:3
标识
DOI:10.1080/09286586.2023.2213324
摘要

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.
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