Minkovitz J B, Pepose J S
Department of Ophthalmology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Cornea. 1995 May;14(3):326-30. doi: 10.1097/00003226-199505000-00017.
The treatment of herpes simplex keratitis has ranged from simple debridement to the use of prototypic antiviral agents specific to the herpes family, such as acyclovir. The various treatment modalities for dendritic keratitis, for the most part, have been effective. However, in recent years numerous reports of antiviral-resistant strains of herpes simplex have appeared, particularly in immunocompromised patients receiving chronic acyclovir. Interferon has been proposed as a possible treatment adjunct in these cases. We report the case of a 46-year-old man on chronic immunosuppressive and acyclovir therapy after a renal transplant who developed ulcerative keratitis due to a strain of herpes simplex virus that was resistant to multiple antiviral agents both in vivo and in vitro. After 7 weeks without improvement on multiple treatment regimens, including trifluridine, vidarabine, debridement, and topical and systemic acyclovir, interferon alpha-2a was added to topical acyclovir therapy, and the keratitis quickly resolved. Topical interferon alpha-2a appears to be an effective treatment adjunct for refractory herpes simplex keratitis in patients with cell-mediated immune dysfunction and subsequent lack of endogenous interferon. Its value in nonimmunocompromised patients remains to be determined.
单纯疱疹性角膜炎的治疗方法多样，从简单的清创术到使用针对疱疹家族的原型抗病毒药物，如阿昔洛韦。对于树枝状角膜炎的各种治疗方式大多是有效的。然而，近年来出现了许多关于单纯疱疹抗病毒耐药菌株的报道，特别是在接受慢性阿昔洛韦治疗的免疫功能低下患者中。在这些病例中，干扰素已被提议作为一种可能的治疗辅助药物。我们报告了一例46岁男性患者，在肾移植后接受慢性免疫抑制和阿昔洛韦治疗，因一株单纯疱疹病毒导致溃疡性角膜炎，该病毒在体内和体外均对多种抗病毒药物耐药。在包括三氟尿苷、阿糖腺苷、清创术以及局部和全身使用阿昔洛韦在内的多种治疗方案治疗7周后仍无改善，于是在局部使用阿昔洛韦治疗中加用了α-2a干扰素，角膜炎迅速消退。局部使用α-2a干扰素似乎是治疗细胞介导免疫功能障碍及随后内源性干扰素缺乏的难治性单纯疱疹性角膜炎的有效辅助治疗方法。其在非免疫功能低下患者中的价值仍有待确定。
