Efficacy of oral antiviral prophylaxis in preventing ocular herpes simplex virus recurrences in patients with and without self-reported atopy.

PURPOSE: To compare the efficacy of oral antiviral prophylactic treatment for herpes simplex virus (HSV) recurrences in patients with and without self-reported atopy. DESIGN: Retrospective cohort comparative study. METHODS: setting: Cornea Service, Wills Eye Hospital. study population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004. From 244 patients invited, 54 patients (58 eyes) were included. One hundred and ninety patients were excluded according to exclusion criteria: no active episode during follow-up, immunosuppression, less than one year of follow-up, or previous history of penetrating keratoplasty. The Questionnaire regarding history of atopic disease, considers: presence of allergic rhinitis, asthma or atopic dermatitis, and chart review of ocular history. main outcome measures: Incidence of all types of HSV recurrences with and without antiviral prophylaxis within each group and between groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Atopic/nonatopic (P value): mean follow-up without prophylaxis 8.1 (+/- 8.2)/7.3 years (+/- 8.6) (P = .71); mean follow-up with prophylaxis 2.9 (+/- 2.3)/2.6 years (+/- 2.2) (P = .51); the effect of prophylaxis significantly reduced the all recurrences in both groups except in the inflammatory recurrences in the atopic group and in the mixed recurrences in both groups. Prophylaxis decreased infectious episodes by 44% in nonatopic and 76% in atopics and decreased inflammatory manifestations by 69% in the nonatopic group and 8% in the atopic group. CONCLUSION: Antiviral prophylaxis for HSV recurrences was more effective in reducing infections in atopics and less effective in reducing inflammatory episodes in atopics versus nonatopics.

Comparative study of ocular herpes simplex virus in patients with and without self-reported atopy.

PURPOSE: To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy. DESIGN: Retrospective cohort comparative study. METHODS: Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up. MAIN OUTCOME MEASURES: Incidence of all types of HSV recurrences. SECONDARY OUTCOME MEASURES: Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26). CONCLUSIONS: Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.

Estudo experimental comparativo da crioterapia, diatermia e laserterapia via "pars plana" / Experimental comparative study of cryotherapy, diathermy and lasertherapy via pars plana

Os estudos histopatologicos das lesöes provocadas por crioterapia, diatermia bipolar coaxial e fotocoagulaçäo com raio laser de argônio da retina via "pars plana" em olhos de coelhos submetidos à facectomia e vitrectomia permitem as seguintes conclusöes:- as lesöes menos intensas causadas pela crioterapia via "pars plana" caracterizaram-se por necrose das camadas internas da retina neuro-sensorial seguida de despolarizaçäo e repolarizaçäo progressiva do epitélio pigmentário. Ocorreu refinamento e gliose correspondente às áreas destruidas. As cicatrizes apresentaram interdigitaçäo marginal entre as células de Muller e as células do epitélio pigmentário; - as lesöes mais intensas causadas pela crioterapia via "pars plana" caracterizaram-se por necrose em toda espessura da retina neuro-sensorial. Observaram-se destruiçäo central e despolarizaçäo marginal seguidas por multiestratificaçäo e proliferaçäo do epitélio pigmentário. Ocorreram afinamento central, migraçäo de macrófagos, gliose e fibrose relacionadas à traçäo local retino-vítrea. As cicatrizes apresentaram interdigitaçäo marginal entre as células de Muller e as células do epitélio pigmentário; - a crioterapia via "pars plana" promoveu adesäo tecidual entre a retina neuro-sensorial, mantendo usualmente a membrana limitante interna íntegra. Ocorreu gliose correspondente às áreas destruidas. As camadas externas e o epitélio pigmentário permaneceram normais; as lesöes mais intensas causadas pela diatermia bipolar coaxial via "pars plana" caracterizaram-se por necrose em toda espessura da retina neuro-sensorial e do epitélio pigmentário, que apresentou despolarizaçäo marginal. O efeito foi progressivo da margem para o centro e levou à formaçäo de buraco com migraçäo de macrófagos, proliferaçäo fibro-vascular lesional e retino-vítrea, neovascularizaçäo da coróide e descolamento tracional de retina; - a diatermia bipolar coaxial via "pars plana" näo promoveu adesäo tecidual entre a retina neuro-sensorial e o epitélio pigmentário. As lesöes retinianas causadas pela fotocoagulaçäo com laser de argonio via "pars plana" mostraram-se semelhantes às obtidas obtidas com o mesmo tipo de fonte energética via transpupilar. As cicatrizes apresentaram proliferaçäo de células do epitélio pigmentário e de células gliais om interdigitaçöes de vilosidades com as células de Muller. A fotocoagulaçäo com raio laser de argônio mostrou-se como o método mais fácil, rápido, seguro e reprodutível ao se utilizar uma abordagem cirúrgica interna para a produçäo de cicatrizes retinianas adesivas via "pars plana"