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Treatment of Pseudodendrites in Herpes Zoster Ophthalmicus With Topical Ganciclovir 0.15% Gel

Aggarwal, Shruti MD; Cavalcanti, Bernardo M. MD; Pavan-Langston, Deborah MD

doi: 10.1097/ICO.0000000000000020
Clinical Science

Purpose: There is no standard of treatment for epithelial pseudodendrites in herpes zoster ophthalmicus (HZO). The purpose of this study is to report the topical antiviral drug, 0.15% ganciclovir for treatment of these lesions.

Methods: This is a retrospective, interventional case series of 4 patients who were diagnosed with HZO epithelial pseudodendrites despite being given oral antiviral treatment and who underwent 0.15% ganciclovir gel topical treatment. Main outcome measures included epithelial healing time, visual acuity, and corneal sensation.

Results: All 4 patients were immunocompetent and had epithelial lesions unresponsive to antiviral treatment with oral valacyclovir. Treatment with topical 0.15% ganciclovir gel 5 times a day resulted in the lesions healing successfully within 7 days with improved visual acuity in 3 patients and an increase in corneal sensation in 2 of the 4 patients.

Conclusions: Topical 0.15% ganciclovir gel, 5 times a day until pseudodendritic lesion healing and tapering to bid for 2 to 4 weeks thereafter, is an effective treatment for pseudodendrites in HZO-affected cases that are often a challenge to manage with other oral or topical antivirals.

Department of Ophthalmology, *Cornea and Refractive Surgery Service; and

Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Reprints: Deborah Pavan-Langston, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114 (e-mail: deborah_langston@meei.harvard.edu).

Supported by the Nancy and Vanderburgh Johnstone Funds (DPL) and the Georgianna Stevens Fund (DPL). The funding organizations had no role in the design or conduct of this research.

The authors have no other funding or conflicts of interest to disclose.

Received August 19, 2013

Accepted September 26, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.