To accomplish these aims, methods from the Scottish Intercollegiate Guideline NetworkAll studies used to form a recommendation for care are graded for strength of evidence individually, and that grade is listed with the study citation.High-quality meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with a very low risk of biasWell-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of biasMeta-analyses, systematic reviews of RCTs, or RCTs with a high risk of biasHigh-quality systematic reviews of case-control or cohort studiesHigh-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causalWell-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causalCase-control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causalNonanalytic studies (e.g., case reports, case series)The following studies were not assigned a SIGN level and were labeled NA: Reviews, Basic Scientific Research, Textbook Chapters, Cost-Effective Analysis, Survey Studies, and Diagnostic Testing.Recommendations for care are formed based on the body of the evidence. The body of evidence quality ratings are defined by GRADEFurther research is very unlikely to change our confidence in the estimate of effectFurther research is likely to have an important impact on our confidence in the estimate of effect and may change the estimateFurther research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimateUsed when the desirable effects of an intervention clearly outweigh the undesirable effects or clearly do notUsed when the trade-offs are less certain-either because of low-quality evidence or because evidence suggests that desirable and undesirable effects are closely balancedThe Findings and Recommendations for Care boxes, located throughout this manuscript, highlight points of particular importance to vision and quality of life outcomes.
However, early detection and appropriate treatment are critical to minimize permanent visual loss.There is one retrospective cohort study comparing systemic and topical acyclovir therapy for the prevention of HSV keratitis recurrences following penetrating keratoplasty.While most clinical trials of oral antiviral prophylaxis in the setting of penetrating keratoplasty used acyclovir, existing evidence suggests other available oral antiviral agents with activity against HSV can be used. However, numerous research studies have been focused on the efficacy of vaccines in the prevention of genital herpes infections.One published study investigated the use of an HSV-1 vaccine to prevent recurrent herpetic ocular disease in humans. Some patients may experience symptoms during this initial acute infection but most patients do not. A second clinical trial conducted by the HEDS group investigated the efficacy of short-term/high-dose oral antiviral in preventing HSV stromal keratitis recurrences over 12 months in patients with active HSV epithelial keratitis at the time of enrollment. A good practice point may emphasize the importance of patient preferences in decision making or feature a practical point for which there is not, nor is there likely to be, any research evidence.In the process of preparing this document, a detailed literature search of PubMed, EMBASE, and the Cochrane Library for articles in the English language was conducted in November 2010 on the subject herpetic keratitis for years 1966–2010. Ask your doctor about any risk.Stop using allopurinol and call your doctor at once if you have:This is not a complete list of side effects and others may occur. Use the medicine exactly as directed.Take each dose with a full glass of water. Cases of HSV epithelial keratitis coincident to administration of latanoprost have been reported.Corticosteroids are potent anti-inflammatory mediators and affect virtually every aspect of the immune response.Bevacizumab (Avastin®; Genentech, San Francisco) and ranibizumab (Lucentis®; Genentech, San Francisco) are humanized monoclonal antibodies to vascular endothelium growth factor used to treat the neovascular form of macular degeneration. The following treatment recommendations address the antiviral agents available in the U.S., with the addition of topical acyclovir, which is not FDA approved as a topical ophthalmic agent, but is widely used outside the U.S. The addition of minimal wiping debridement to a topical antiviral agent may be of limited or no benefit. Topical acyclovir ointment is effective against HSV epithelial keratitis, but is unavailable in the U.S.A topical corticosteroid agent in conjunction with an oral antiviral agent for at least ten weeks is the preferred treatment for HSV stromal keratitis.
One study evaluated three different diagnostic tests against the gold standard of viral isolation in 170 patients diagnosed with keratitis of possible HSV etiology.