EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78710
May 2012 EW CORNEA 51 hundreds and hundreds of dollars for a 1-month dose. "Now that many companies are funding generic Valtrex in their insurance plans, we have a much better alter- native because we can use lower doses," Dr. Sheppard said. Famciclovir is also a pro-drug, however, Dr. Sheppard pointed out that this remains expensive. These agents tend to be forgiving ones. "All of these drugs are viral DNA specific—they're not at all toxic to humans," he said. "I've given these drugs to elderly, sick patients, pa- tients with renal failure in reduced doses, and pregnant patients, infants, and children." For stromal keratitis, steroids are essential to prevent scarring and blood vessel formation. However, they must be given in conjunction with antiviral medication. "If one employs a steroid by itself you po- tentiate the virus and increase the rate and severity of reactivation," Dr. Sheppard said. "It's bad to give a patient who might have herpetic disease a steroid by itself." Another way to inhibit the inflammatory process of stromal herpes keratitis is with topical cyclosporine. In a July 2010 study published in Archives of Ophthalmol- ogy, Dr. Sheppard and fellow investi- gators showed that patients given Restasis (Allergan, Irvine, Calif.) for stromal herpetic disease had milder outbreaks. "It reduced the severity and the frequency of recurrence," Dr. Sheppard said. "The immune mechanism of Restasis is T-cell medi- ated so mechanistically it makes sense that Restasis would work." Going forward, Dr. Sheppard thinks that it would be nice to intro- duce an ointment preparation that would allow for less frequency of usage. But he acknowledged that this is less convenient and is a form that many patients don't like. He is also hopeful that a vaccine may emerge. "There is tremendous active research by brilliant basic scientists in a number of centers on a vaccine for herpetic disease," he said. "These efforts have truly increased our un- derstanding of the mechanisms of dormancy and reactivation and the type of DNA that is actively tran- scribing during latency as opposed to active infection." EW Editors' note: Dr. O'Brien has financial interests with Alcon (Fort Worth, Texas), Allergan, Bausch + Lomb, ISTA (Irvine, Calif.), Merck (Whitehouse Station, N.J.), and Santen Pharmaceuti- cal (Osaka, Japan). Dr. Sheppard has financial interests with Alcon, Allergan, and Bausch + Lomb. Contact information O'Brien: 561-515-1544, tobrien@med.miami.edu Sheppard: 757-622-2200, docshep@hotmail.com