Knickelbein Jared E, Hendricks Robert L, Charukamnoetkanok Puwat
Medical Scientist Training Program, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Surv Ophthalmol. 2009 Mar-Apr;54(2):226-34. doi: 10.1016/j.survophthal.2008.12.004.
Herpes simplex virus (HSV) stromal keratitis is a leading cause of corneal opacification and an important indication for penetrating keratoplasty. Based on several observational studies and clinical trials, the current standard of care includes topical corticosteroids and antivirals. However, corticosteroids have significant side effects, and antivirals are only beneficial if replicating virus is present. High-quality clinical trials investigating therapies for HSV stromal keratitis beyond corticosteroids and antivirals are lacking. Immune regulatory drugs, such as cyclosporine A, present attractive alternatives to managing HSV stromal keratitis, given the immune-mediated pathogenesis of stromal disease. Also, inhibiting viral reactivation in the latently infected ganglia through therapeutic vaccination will likely be the most efficient avenue to reduce recurrent HSV ocular disease. Our present aim is to review the current evidence-based treatment options for HSV stromal keratitis including and beyond the use of corticosteroids and antivirals and to cultivate insights into developing therapeutic vaccination strategies to inhibit HSV stromal keratitis recurrences.
单纯疱疹病毒性（HSV）基质性角膜炎是角膜混浊的主要原因，也是穿透性角膜移植术的重要指征。基于多项观察性研究和临床试验，目前的标准治疗方法包括局部使用皮质类固醇和抗病毒药物。然而，皮质类固醇有显著的副作用，而且只有在存在复制病毒时抗病毒药物才有益。缺乏针对HSV基质性角膜炎除皮质类固醇和抗病毒药物之外的治疗方法的高质量临床试验。鉴于基质性疾病的免疫介导发病机制，免疫调节药物，如环孢素A，是治疗HSV基质性角膜炎有吸引力的替代方案。此外，通过治疗性疫苗接种抑制潜伏感染神经节中的病毒再激活可能是减少复发性HSV眼部疾病最有效的途径。我们目前的目的是回顾HSV基质性角膜炎目前基于证据的治疗选择，包括使用和不使用皮质类固醇和抗病毒药物的情况，并深入了解制定抑制HSV基质性角膜炎复发的治疗性疫苗接种策略。
