V 677
Prevention of herpetic keratitis at the new millennium
B. Cochener
Purpose: To present the current French protocol of prevention for herpetic keratitis, based on results of the multicenter French study and on recent approach to the pathogenesis of the disease.
Material and Methods: Mechanism and treatment of ocular lesions induced by herpes simplex virus are correctly controlled, considering epithelial and inflammatory stromal keratitis. Gravity of herpetic disease is related to severe recurrences. We will discuss the two admitted origins of their occurrence, represented by the virus reactivation (anterograde way) and virus latency (retrograde way). The specific role of recently identified "Latency Associated Transcripts" (LAT) will be underlined.
Results: Epidemiological evaluation estimate that frequency of herpetic keratitis recurrence at one year is 10% and 40% at 5 years after the initial episode. Various clinical trials have been conducted to assess the effect of Acyclovir (ACV) and Valacyclovir (VACV) in the potential prevention of ocular herpetic recurrence. Compared to placebo (PCB), acyclovir provides a significant decrease in herpetic resurgence (19% with ACV versus 32% with PCB). Pharmacokinetic of VACV explains a better bioavailability than ACV, associated to a longer life duration.
Discussion – Conclusion: Criteria for directions of use for specific antiviral drugs and official agreement for indications of prevention are still debated. Meanwhile, research are focused on the adjustment of a vaccination for suppression of virus latency.
University of Brest, Chu Morvan, Service dÂ’Ophtalmologie, 5 Avenue Foch, 29609 Brest-Cedex, France