The Charles T. Campbell Eye Microbiology Lab
UPMCUniversity of Pittsburgh Schools of the Health Sciences
HomeContact InformationLab Diagnostic TestingAntibiotic SusceptibilityAntimicrobial TherapyCurrent ResearchPhotos

Ocular Microbiology and Immunology Group
Back to OMIG Main Page

2017 Agenda and Abstracts | < Previous Next >


2017 OMIG Abstract 4

Successful Treatment of Herpes Simplex Keratitis with Oral Valganciclovir in Patients Unresponsive to Conventional Antiviral Therapy
N. Dilruba Koseoglu, MD, Benjamin R. Strauss, MD, Pedram Hamrah, MD
Center for Translational Ocular Immunology, Department of Ophthalmology and Cornea Service,
New England Eye Center, Tufts Medical Center, Boston, Massachusetts

Purpose: To describe four immunocompetent patients with recurrent herpes simplex virus (HSV) keratitis unresponsive to conventional antiviral therapy that improved with oral valganciclovir treatment.

Background: Herpes simplex keratitis is one of the leading causes of blindness in developed countries. Treatment in a timely manner and adequate prophylaxis is crucial for preservation of vision. The current treatment options include a variety of nucleoside analogues; such as oral acyclovir, valacyclovir, penciclovir, famciclovir and topical ganciclovir, as well as DNA synthesis inhibitors such as foscarnet and cidofovir. Failure with conventional therapies in HSV keratitis can be challenging and result in permanent vision loss.

Methods: Retrospective case series of four patients with HSV keratitis treated with oral valganciclovir between March 2016 and August 2017.

Results: We reviewed the records of four patients with recurrent HSV keratitis. Three patients had a history of HSV keratitis and were on antiviral prophylaxis. One patient had a history of Bell’s palsy and developed HSV keratitis after cataract surgery. Three patients that presented with dendritiform epithelial keratitis were initially treated with acyclovir, valacyclovir or famciclovir for 4 to 6 months with persistent recurrences. Recurrences and failure to treatment led us to the conclusion of a possible drug resistance. We initiated oral valganciclovir 900 mg BID for 10 days as a treatment dose followed by 900 mg daily for prophylaxis. The fourth patient presented with recurrent dendritiform epithelial keratitis after discontinuing the prophylactic valacyclovir due to an allergic reaction. The patient was initially treated with famciclovir but switched to valganciclovir 450 mg daily in the second week due to an allergic reaction as well. The epithelium healed in the first two weeks in all four patients. The mean time of follow up for patients on prophylaxis was 8 months (range: 5-12 months) and none of the patients presented with any further recurrences.

Conclusion: In case of failed treatment with conventional antiviral therapies, oral valganciclovir can present a good alternative for the treatment and prophylaxis of herpetic keratitis.

Disclosure: S

Funding support: NIH R01-EY022695 (PH), Massachusetts Lions Eye Foundation


2017 Agenda and Abstracts | < Previous Next >