Do Punctal Occlusion and Cyclosporine Reduce Reactivation of Herpes Simplex Keratitis?
July 21, 2009
Permanent punctual occlusion and topical cyclosporine use lowered the recurrence of herpes simplex keratitis (HSK), researchers said in the Archives of Ophthalmology July Issue.
In a nonrandomized, single-center, retrospective, comparative analysis, forty-two patients with both dry eye disease and HSK were enrolled. Twenty-two patients were treated with punctal occlusion by thermal cautery and 10 were treated with topical administration of 0.05% cyclosporine two times a day. Ten other patients who had previously undergone punctal occlusion started the cyclosporine twice a day. All of the patients were on oral acyclovir or valacyclovir hydrochloride and topical steroid drops and were followed for one year.
The group with thermal cautery had experienced 2.1 HSK recurrences per year before treatment; this was reduced to 0.45 recurrences per year after treatment (P = .01). In the topical cyclosporine group, the annual frequency of HSK recurrences was reduced from 1.8 to 0.43 (P = .02). Addition of topical cyclosporine to patients with prior thermal cautery further reduced their frequency of HSK recurrences to 0.40 per year (P = .05).
The authors conclude that both permanent punctal occlusion by thermal cautery and the use of topical cyclosporine independently reduced recurrences of stromal HSK in these patients. Since HSK can be such a debilitating condition, these findings deserve further evaluation to add to the current treatment arsenal.
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