1. Herpetic Eye disease study (HEDS) Presented by :
Majed Mohammed Al-Obailan, MD

2. Classification of A/S ocular HSV disease
1.Primary infection:
A. neonatal.
B. primary (childern, adults)

3. Classification of A/S ocular HSV disease
2.Recurrent infection
A. Blephritis
B. Conjunctivitis

4. C. Infectious dendritic or geographic epithelial keratitis

5. D. Sterile corneal trophic ulceeration.
E. Stromal immune keratitis
1. Interstitial keratitis.
2. Immune rings
3. Limbal vasculitis
4. Disciform keratitis

6. Disciform keratits

7. Necrotizing
Stromal
keratitis

9. F. Endotheliitis and trabeculitis
G. Iridocyclitis

10. Objective:
5 trials to evaluate the role of steroids and antiviral medication in the treatment and prevention of ocular HSV disaese.

11. 1-Effecacy of oral acyclovir in treating stromal keratitis (non-necrotizing [disciform] and necrotizing):
10 weeks course of ACV 400 mg 5x/day or placebo, in addition to topical steroid and trifluridine.

12. No improvement in:
1- No. of Rx failures.
2- time to resolution.
3- 6/12 BCVA.
Oral acyclovir is XXXX in stromal keratitis.

13. 2- Efficacy of topical corticosteroids in treating stromal keratitis :
10-week tapering course of prednisolone phosphate 8x/day or placebo in addition to topical trifluridine (viroptic) QID X1/52 then gradual taper.

14. Topical steroids are beneficial for the Rx of stromal keratitis.
Topiacl steroid
1- reduce the risk of persistance or progressive stromal keratitis by 68%.
2- shortened the duration of keratitis.
Topical steroids are beneficial for the Rx of stromal keratitis.

15. 3- Efficacy of oral acyclovir in treating iridocyclitis:
10-week course of ACV 400 mg 5x/day or placebo, in addition to topical trifluridine.

16. Trial was stopped due to slow recruitment.
Rx failure occurred in 50% of the ACV group vs 68% in of the placebo group.
Result were not statistically significant but suggest a possible benefit of oral acyclovir for the Rx of iridocyclitis.

17. 4- efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis:
3-week course of ACV 400 mg 5x/day or placebo, in addition to topical trifluridine.

18. Oral acyclovir did not reduce the risk of stromal keratitis or iritis development in patients with epithelial disease.
11% in ACV group vs 10% in placebo group.
It was more common in those with old Hx of stromal keratitis or iritis( 23% vs 9% in those without previous Hx.

19. In patients with epithelial keratitis, a 3-week course of oral ACV is XXXX in preventing stromal keratitis or iritis.

20. 5- efficacy of oral acyclovir in preventing recurrent ocular HSV disease:
12-month course of ACV 400 mg BID or placebo and 6/12 observation period for patients with a Hx of ocular HSV within the preceding year.

21. Oral acyclovir reduce the risk of recurrent ocular disease during the treatment period (19% vs 32%)
Especialy in in stromal keratitis subset(14% vs 28%).
Non-ocular HSV lower in Rx group(19% vs 36%).
No rebound in the rate of the disaese in 6/12.

22. Oral acyclovir prophylaxis significantly reduces the risk of recurrent of ocular and orofacial HSV disease, especially in pts with previous stromal keratitis .

23. 6- Determinants of recurrent HSV keratitis:
Analyzed the placebo group from the prevention acyclovir trial.

24. In the placebo group of the previous trial, 18% developed epithelial keratitis and 18% developed stromal keratitis.
Previuos epithelial keratitis did not significantly affect the subsequent risk of epithelial keratitis , and previous stromal keratitis significantly increased the subsequent of stromal keratits (10x).

25. In patients with ocular HSV disease in the previous year, a history of epithelial keratitis is not a risk factor for recurrent epithelial keratitis , but a history of stromal keratitis increases the risk of subsequent stromal keratitis, and this risk is strongly associated with No. of previous episodes.

26. 2- Topical steroids are beneficial for the Rx of stromal keratitis.
CONCLOSION
1- Oral acyclovir is XXXX in stromal keratitis.
2- Topical steroids are beneficial for the Rx of stromal keratitis.

27. CONCLOSION
3- Result were not statistically significant but suggest a possible benefit of oral acyclovir for the Rx of iridocyclitis.
4- In patients with epithelial keratitis, a 3-week course of oral ACV is XXXX in preventing stromal keratitis or iritis.

28. CONCLOSION
5- Oral acyclovir prophylaxis significantly reduces the risk of recurrent of ocular and orofacial HSV disease, especially in pts with previous stromal keratitis .

29. CONCLOSION
6- In patients with ocular HSV disease in the previous year, a history of epithelial keratitis is not a risk factor for recurrent epithelial keratitis , but a history of stromal keratitis increases the risk of subsequent stromal keratitis, and this risk is strongly associated with No. of previous episodes.

30. THANK YOU