Antiviral and Anti-Inflammatory Therapeutic Interventions for Treating Herpes Stromal Keratitis: A Systematic Review

ABSTRACT

Purpose

Herpes stromal keratitis (HSK) is an immune-mediated corneal inflammation that occurs after a herpes simplex virus infection. This paper aims to systematically identify and compare interventions for treating HSK and their patient outcomes.

Methods

This systematic review followed the PRISMA methodology. Online databases were searched to obtain all relevant papers. Two independent reviewers screened through 168 records. Seven papers were included and used for data extraction. A qualitative analysis was conducted.

Results

HSK patients receiving prednisolone phosphate and acyclovir showed a higher treatment success rate and significantly longer time to failure compared to patients receiving only acyclovir (P < .001). No difference in resolution time was found between oral and topical acyclovir. Between groups receiving dexamethasone and flurbiprofen, resolution occurred in 93% and 67% of patients, and BCVA (LogMAR) improved from 1.0 to 0.30 and 0.48, respectively. BCVA improved in both cyclosporine-A (P < .001) and its control (prednisolone) groups (P = .002). A tacrolimus treatment group showed greater improvement in BCVA compared to its control (prednisolone) group (P < .001).

Conclusion

Corticosteroids and antivirals managed HSK most effectively only when used concurrently. Oral acyclovir showed similar effectiveness to its ointment counterpart, a preferable alternative for easier administration. Corticosteroid use could induce greater therapeutic benefits when tapered in concentration and frequency and administrated for at least 10 weeks. Anti-inflammatory drugs including flurbiprofen, cyclosporine-A, and tacrolimus could be safe and effective for treating HSK. Future long-term follow-up and RCTs could provide insights on the therapeutic benefits of these potential alternatives.

KEYWORDS:

• Herpes Stromal Keratitis
• systematic Review
• corneal inflammation
• prednisolone phosphate
• acyclovir

Acknowledgments

Conceived experiment: XL, MN, MSMM. Conducted experiment: XL, MN. Writing of the paper: XL. Critical revision of the paper: XL, MN, MSMM. All data produced and analyzed in the study are included in this published paper and its supplemental files.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

There was no funding obtained for the conducting of this systematic review or the creation of this manuscript. None of the authors have any proprietary interests or conflicts of interest related to this submission. This submission has not been published anywhere previously and it is not simultaneously being considered for any other publication.