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2013 Agenda and Abstracts | < Previous | Next >

2013 OMIG Abstract 25

Treatment of Active Pseudodendrites in Herpes Zoster Ophthalmicus with Topical Ganciclovir 0.15% Gel
Shruti Aggarwal M.D., Bernardo M. Cavalcanti M.D., Deborah Pavan-Langston M.D.
Cornea and Refractive Surgery Service. Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA

Purpose: Acute and recurrent epithelial pseudodendrites in Herpes Zoster Ophthalmicus (HZO) almost invariably harbor active virus DNA and warrant antivirals. However, due to unreliable therapeutic success there is no standard of treatment. Ophthalmologists must often try oral or topical antivirals in varying combinations, dosages and regimens. Topical 0.15% ganciclovir has recently been approved for Herpes simplex keratitis. The purpose of this study was to evaluate the efficacy of topical ganciclovir in active, HZO pseudodendrites which were unresponsive to oral anti-viral therapy.

Methods: Retrospective, interventional case series of 4 HZO patients with a total of 5 episodes of persistent pseudodendritic keratitis despite systemic antiviral therapy. All the episodes were treated with 0.15% topical ganciclovir gel. Epithelial healing time, visual acuity and corneal sensation were recorded.

Results: All 4 patients were above 50 years of age and immunocompetent. They had persistent epithelial lesions unresponsive to oral antivirals. Treatment with topical 0.15% ganciclovir gel 5 times/day resulted in healing of the lesions within a week. Treatment was tapered to 2 times/day for 2 to 4 weeks and then stopped. Three patients had improved visual acuity and an increase in corneal sensation was observed in 2 out of 4 patients.

Conclusion: Topical 0.15% ganciclovir gel, 5 times/day until the pseudodendritic lesions heal then tapered to 2 times/day and stopped within a month, is an effective treatment for pseudodendrites in HZO cases which are often a challenge to manage with other oral or topical antivirals.

Funding: N & V Johnstone Funds and the Stevens Fund; AAO Disclosure: N

2013 Agenda and Abstracts | < Previous | Next >