PURPOSE: We reported a case of squamous cell carcinoma in a patient with chronic herpetic keratitis treated with Mitomycin C. METHODS: In a patient with 13-year recurrent chronic herpetic keratitis, we diagnosed invasive squamous cell carcinoma in papillary mass with no response of previous treatment by conjunctival biopsy. RESULTS: After surgical removal and chemotherapy of 0.04% topical Mitomycin C, the eye showed histopathological resolution of squamous cell carcinoma.
Biopsy ; Carcinoma, Squamous Cell* ; Drug Therapy ; Humans ; Keratitis, Herpetic* ; Mitomycin

OBJECTIVEUsing pharmacokinetics to explore the mechanism of honey to enhance the efficacy of acyclovir (ACV) treatment of herpes simplex keratitis (HSK), providing the basis for combination of the prescription of two drugs and dosage regimen designed.

METHODSingle dosages of 5% honey and 0% honey Meyasu eye ointment are injected into rabbit eyes. The aqueous humor of rabbit eye is measured at different times, specifically the content of ACV in aqueous humor by HPLC. Mathematical models are established, from which pharmacokinetic parameters are extracted and compared by mathematics and statistics methods.

RESULTBoth the 5% and 0% honey Meyasu eye ointment in rabbit eyes are belong to a two-compartment model. The absorption half-life of the 5% Meyasu eye ointment in aqueous humor is as 2.30 times longer, the distribution half-life is 2.12 times longer, the peak concentration is 1.17 times longer, the peak time is 1.36 times longer, AUC is 1.41 times longer when compared to the 0% Meyasu eye ointment.

CONCLUSIONHoney can significantly increase the ACV concentration and bioavailability in the eye, extend the action time of ACV in target cells and increase the retention capacity of ACV in the target tissue; thereby improving treatment success.

Acyclovir ; pharmacokinetics ; therapeutic use ; Animals ; Antiviral Agents ; pharmacokinetics ; therapeutic use ; Disease Models, Animal ; Eye ; drug effects ; metabolism ; Female ; Honey ; analysis ; Humans ; Keratitis, Herpetic ; drug therapy ; metabolism ; Male ; Rabbits

BACKGROUNDHerpes simplex keratitis (HSK) caused by herpes simplex virus 1 (HSV-1), which has high recurrent rate and incidence of severe vision loss, is the leading cause of infectious blindness in the world. The aim was to explore the clinical efficacy of oral ganciclovir (GCV) in the prevention of recurrent HSK.

METHODSA multicenter, prospective, randomized, single-blind, and controlled clinical trial was conducted from April 2010 to June 2013. One hundred seventy-three patients (173 eyes involved) who were diagnosed as recurrent HSK definitely, including stromal keratitis and corneal endotheliitis, were divided into three groups randomly: negative control (placebo) group was topically administered with 0.15% GCV ophthalmic gel, 4 times per day and 0.1% fluorometholone eye drops, 3 times per day until resolution of HSK; positive control acyclovir (ACV) group was topically adopted the same ophthalmic gel and eye drops and additionally received oral ACV 400 mg 5 times a day for 10 weeks and followed by 400 mg 2 times per day for 6 months; test GCV group was topically adopted the same treatment as negative control group and additionally received oral GCV 1000 mg 3 times per day for 8 weeks. The symptoms and signs were evaluated before and after the therapy 1 st week, 2 nd week and then followed up every 2 weeks until recovery. Furthermore, we followed up recurrence of HSK for every 3 months after recovery and then assessed the cure time, recurrent rate and adverse reactions.

RESULTSOne hundred and seventy-three patients were followed up 7-48 months (mean 32.1 ± 12.3 months), but 34 patients were failed to follow-up. The cure time was 12.1 ± 4.3, 11.9 ± 4.0 weeks in negative control (placebo) group and positive control ACV group respectively (P = 0.991), which was longer than that in test GCV group (8.6 ± 2.8 weeks) and there was a significant difference between test GCV group and negative control (placebo) group or positive control ACV group (P = 0.000). Furthermore, the recurrent rate was higher in negative control (placebo) group (47.3%) than that in positive control group ACV (26.7%) and test GCV group (17.2%), and there was a great significant difference among the three groups (P = 0.007), but there was no significant difference between positive control ACV group and test GCV group (P = 0.358). In addition, there was no obvious adverse reaction expect neutropenia (only one patient in test GCV group).

CONCLUSIONShort-term oral GCV could cure recurrent HSK and endotheliitis, shorten the course, reduce recurrent rate of HSK and have confirmed safety.

Adult ; Aged ; Antiviral Agents ; administration & dosage ; therapeutic use ; Female ; Ganciclovir ; administration & dosage ; therapeutic use ; Humans ; Keratitis, Herpetic ; drug therapy ; Male ; Middle Aged ; Single-Blind Method ; Treatment Outcome

OBJECTIVETo evaluate the role of acyclovir in treatment and prevention of herpes simplex keratitis (HSK).

METHODSA total of 105 patients with HSK were divided into 4 groups. Group 1 consisted of 79 patients with HSV epithelial keratitis. Group 2 consisted of 20 patients with interstitial keratitis. Group 3 consisted of 6 patients with necrotizing keratitis. Group 4 consisted of 4 necrotizing keratitis patients with corneal perforation treated with conjunctival flap and corneal transplantation. All patients were treated with acyclovir systemically and topically. After full recovery, the patients with epithelial HSK and stromal HSK were randomly divided into two groups individually. One group was constantly treated with oral acyclovir at 300 mg/day for 1 year as a prophylaxis group. The other group was designated as control.

RESULTSDuring the one-year treatment and follow-up, 5 cases with epithelial HSK recurred in the prophylaxis group and 14 cases in the control group, showing a statistically significant difference. One case of stromal HSK recurred in the prophylaxis group and 4 recurred in the control group.

CONCLUSIONLong term and low dose oral acyclovir for prophylaxis of recurrent epithelial herpes simplex infection and therapeutic doses of oral acyclovir reduce both the rate and duration of recurrences of infectious herpes simplex keratitis.

Acyclovir ; therapeutic use ; Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Child ; Female ; Humans ; Keratitis, Herpetic ; drug therapy ; prevention & control ; Male ; Middle Aged ; Recurrence

Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV). However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior. A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections. Six months postoperatively, there was significant regression of the neovascular area and vessel caliber. Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection. The findings may suggest a new prospect in treating corneal NV.
Adult ; Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Conjunctiva/blood supply ; Corneal Neovascularization/*drug therapy ; Corneal Stroma/blood supply ; Female ; Humans ; Injections, Intraocular/methods ; Keratitis, Herpetic/*drug therapy ; Visual Acuity/drug effects

OBJECTIVETo explore the influence of Astragalus membranaceus (AM) on serum cytokines, Th1, including interleukin-2 (IL-2) and gamma-interferon (gamma-IFN), and Th2, including interleukin-4 (IL-4) and interleukin-10 (IL-10), in patients with herpes simplex keratitis (HSK).

METHODSOne hundred and six HSK patients were randomly divided into the AM treated group and the ribavirin treated group. Levels of serum IL-2, IL-4, IL-10 and gamma-IFN of all the patients and 62 healthy person, selected from donors for control group, were determined by sandwich enzyme-linked immunosorbent assay (ELISA) technique.

RESULTSLevels of serum IL-4 and IL-10 in HSK patients were significantly higher and those of IL-2 and gamma-IFN were significantly lower than those in the healthy control (all P < 0.01). These parameters were significantly improved in the patients of the AM group after treatment, but with no change in patients of the ribavirin group.

CONCLUSIONAM can modulate the imbalance state of Th1/Th2 in HSK patients, improve their immune function disturbance, that shows important significance in treating HSK.

Adjuvants, Immunologic ; therapeutic use ; Adolescent ; Adult ; Aged ; Astragalus membranaceus ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Keratitis, Herpetic ; drug therapy ; immunology ; Male ; Middle Aged ; Phytotherapy ; Ribavirin ; therapeutic use ; Th1 Cells ; immunology ; Th2 Cells ; immunology