Letters to the Editor
To the Editors:
I read with interest the article by Vadoothker et al.1 The authors present an interesting review in the pathogenesis and management of herpes simplex virus (HSV) keratitis in the pediatric population. Although the authors highlight the fact that the treatment of HSV keratitis in children is challenging, however, some comments can be added to the management section of this article. Epithelial keratitis can be treated with topical antivirals at discretion of the treating physician, with good results in most of the cases without the need of systemic medication, using either 3% acyclovir ointment when available (in Europe or Latin-American), trifluridine or more recently ganciclovir ointment.2,3 The adequate dosage of oral acyclovir is still debated, and while some guidelines recommend 12–20 mg/kg/day, there are some studies endorsing different dosages with good results. The group of Liu et al4 divided the medical therapy in infants, toddlers, young children or older children. Our group described in a larger series of patients, the treatment of oral acyclovir started at a dose of 400 mg/day in children younger than 2 years and 800 mg/day in those older than 2 years, divided in 5 doses and for those able to take pills, 400 mg 5 times daily, showing good results and a low rate of adverse events secondary to the medication.2 Due to the recurrent nature of HSV disease in children, the median recurrence time of 12–15 months reported in some series, and the good long-term tolerability of oral acyclovir, the appropriate time of prophylaxis might be longer than 1 year in specific cases.2,4,5 Finally, I emphasize the value of this article in supporting the need of further studies to determine appropriate guidelines and the best treatment for HSV keratitis.
Juan Carlos Serna-Ojeda, MD, MSc
Banco de Ojos y Tejidos de Aguascalientes
1. Vadoothker S, Andrews L, Jeng BH, et al. Management of herpes simplex virus keratitis in the pediatric population. Pediatr Infect Dis J. 2018;37:949–951.
2. Serna-Ojeda JC, Ramirez-Miranda A, Navas A, et al. Herpes simplex virus disease of the anterior segment in children. Cornea. 2015;34 Suppl 10:S68–S71.
3. Roozbahani M, Hammersmith KM. Management of herpes simplex virus epithelial keratitis. Curr Opin Ophthalmol. 2018;29:360–364.
4. Liu S, Pavan-Langston D, Colby KA. Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes. Ophthalmology. 2012;119:2003–2008.
5. Serna-Ojeda JC, Loya-Garcia D, Navas A, et al. Long-term outcomes of pediatric penetrating keratoplasty for herpes simplex virus keratitis. Am J Ophthalmol. 2017;173:139–144.