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Successful Management of Herpes Simplex Keratitis With Oral Valganciclovir in Patients Unresponsive or Allergic to Conventional Antiviral Therapy

Koseoglu, Neslihan Dilruba, MD; Strauss, Benjamin R., MD; Hamrah, Pedram, MD, FRCS

doi: 10.1097/ICO.0000000000001917
Clinical Science
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Purpose: To describe 4 cases of presumably immunocompetent patients with herpes simplex virus (HSV) keratitis unresponsive (n = 3) or allergic (n = 1) to conventional antiviral therapy that improved with oral valganciclovir treatment.

Methods: Retrospective case series of 4 patients with HSV keratitis treated with oral valganciclovir between March 2016 and June 2018.

Results: We reviewed the records of 4 patients with recurrent epithelial HSV keratitis. Three patients were on antiviral prophylaxis because of a history of HSV keratitis. All patients were on oral acyclovir, valacyclovir, and/or famciclovir treatment with/without topical antiviral therapy for 4 to 6 months for prophylaxis and/or recurrent dendriform epithelial keratitis. While 3 patients had recurrent episodes during their active prophylaxis with oral antiviral therapies, one patient had a recurrence after she discontinued her oral prophylactic antiviral therapy due to recurrent self-reported allergic reactions. The patients presented with recurrent dendriform epithelial keratitis despite conventional antiviral therapy. We initiated oral valganciclovir 900 mg twice a day for 10 days as a treatment dose, followed by 900 mg daily for prophylaxis. The corneal epithelium subsequently healed within the first 2 weeks in all patients. The mean follow-up time for patients on valganciclovir prophylaxis was 8 months (range: 6–12 months), and none of the patients presented with any further recurrences.

Conclusions: In case of treatment-related side effects or failure with conventional antiviral therapies, oral valganciclovir may present an alternative for the treatment and prophylaxis of HSV keratitis.

Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.

Correspondence: Pedram Hamrah, MD, FRCS, Cornea Service, New England Eye Center/Tufts Medical Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111 (e-mail: pedram.hamrah@tufts.edu).

Funding was provided through grants from NIH R01-EY022695 (PH) and Massachusetts Lions Eye Foundation.

The authors have no conflicts of interest to disclose.

This study was presented, in part, at the Ocular Microbiology and Immunology Group Meeting; November 10, 2017, Chicago, IL.

Received August 01, 2018

Received in revised form January 21, 2019

Accepted January 23, 2019

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