Hoang-Xuan T, Büchi E R, Herbort C P, Denis J, Frot P, Thénault S, Pouliquen Y
Hôpital Hôtel-Dieu, Paris, France.
Ophthalmology. 1992 Jul;99(7):1062-70; discussion 1070-1. doi: 10.1016/s0161-6420(92)31849-4.
Reports on the natural history of herpes zoster ophthalmicus stress its high morbidity related to vicious scars on eyelids, ocular complications, and post-herpetic neuralgia. Early treatment with oral acyclovir is effective, but the optimal duration of treatment has not been defined.
The authors performed a bicentric, prospective, randomized, double-masked study of 86 patients with acute herpes zoster ophthalmicus, within 72 hours of skin eruption, who received oral acyclovir (800 mg 5 times daily), either for 7 days (plus 7 days oral placebo) or for 14 days. All patients concomitantly received ophthalmic 3% acyclovir ointment; follow-up was at least 6 months.
Statistical analyses of subjective symptoms, skin lesions, and ocular complications showed no significant differences between the groups, suggesting that a 7-day course of treatment was sufficient. Drug tolerance was good. Pooled data from both groups corroborated earlier reports that prompt treatment with oral acyclovir reduces the severity of the skin eruption, the incidence and severity of late ocular manifestations, and the intensity of postherpetic neuralgia. At 6 months, late ocular inflammatory complications were seen in 29.1% of our 86 patients, versus 50% to 71% of untreated patients described by others. Only 13% of our patients experienced post-herpetic neuralgia, which in no case required the use of analgesics.
The authors believe it is not useful to prolong treatment with 800 mg of oral acyclovir 5 times daily for more than 7 days in herpes zoster ophthalmicus. This study confirms the efficacy of oral acyclovir not only against skin lesions and ocular complications, but also against postherpetic neuralgia in herpes zoster ophthalmicus.
关于眼部带状疱疹自然病史的报告强调了其与眼睑严重瘢痕、眼部并发症及疱疹后神经痛相关的高发病率。口服阿昔洛韦早期治疗有效，但最佳治疗时长尚未明确。
作者对86例急性眼部带状疱疹患者进行了一项双中心、前瞻性、随机、双盲研究，这些患者在皮疹出现72小时内接受口服阿昔洛韦（每日5次，每次800毫克）治疗，治疗时长为7天（加7天口服安慰剂）或14天。所有患者均同时接受3%阿昔洛韦眼膏治疗；随访至少6个月。
对主观症状、皮肤损害及眼部并发症的统计分析显示，两组之间无显著差异，这表明7天疗程的治疗已足够。药物耐受性良好。两组汇总数据证实了早期报告，即口服阿昔洛韦迅速治疗可减轻皮疹严重程度、降低晚期眼部表现的发生率及严重程度，并减轻疱疹后神经痛的强度。在6个月时，我们86例患者中有29.1%出现晚期眼部炎症并发症，而其他研究中未治疗患者的这一比例为50%至71%。我们的患者中只有13%经历了疱疹后神经痛，且无一例需要使用镇痛药。
作者认为，对于眼部带状疱疹患者，每日5次口服800毫克阿昔洛韦的治疗延长超过7天并无益处。本研究证实了口服阿昔洛韦不仅对皮肤损害和眼部并发症有效，而且对眼部带状疱疹的疱疹后神经痛也有效。
