Mori Y, Inoue Y, Shimomura Y
Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
Jpn J Ophthalmol. 1994;38(4):407-10.
Dendritic keratitis occurred during oral acyclovir (ACV) therapy in a 60-year-old man. Corneal stromal edema and iritis were found at his first visit. Herpetic keratouveitis was suspected, based on clinical findings and previous history. Treatment with steroid eyedrops and ACV ointment was initiated. However, ACV [corrected] ointment was changed to oral ACV, since conjunctival ulcer occurred as an adverse effect of the ointment. Subsequently, he received long-term oral ACV medication and steroid eyedrops for recurrent keratitis. The fifth recurrence was also treated with oral ACV and steroid eyedrops. At this time, although the stromal keratitis had improved, there was an outbreak of dendritic keratitis. The lesion healed spontaneously after only a reduction in the steroid. The 50% effective dose (ED)50 of the isolated virus to ACV was 4.4 +/- 0.15 micrograms/ml (mean +/- SD), a level considered ACV-resistant in vitro. The clinical course of this case emphasizes that it is important to consider the route and duration of ACV administration and the use of steroids in the treatment of stromal keratitis or keratouveitis.
一名60岁男性在口服阿昔洛韦（ACV）治疗期间发生了树枝状角膜炎。首次就诊时发现角膜基质水肿和虹膜炎。根据临床表现和既往病史，怀疑为疱疹性角膜葡萄膜炎。开始使用类固醇眼药水和阿昔洛韦眼膏治疗。然而，由于眼膏出现结膜溃疡的不良反应，将阿昔洛韦眼膏改为口服阿昔洛韦。随后，他因复发性角膜炎接受了长期口服阿昔洛韦药物和类固醇眼药水治疗。第五次复发时也采用口服阿昔洛韦和类固醇眼药水治疗。此时，虽然基质性角膜炎有所改善，但出现了树枝状角膜炎发作。仅在减少类固醇用量后，病变就自行愈合了。分离出的病毒对阿昔洛韦的50%有效剂量（ED）50为4.4±0.15微克/毫升（平均值±标准差），这一水平在体外被认为是对阿昔洛韦耐药的。该病例的临床过程强调，在治疗基质性角膜炎或角膜葡萄膜炎时，考虑阿昔洛韦的给药途径和持续时间以及类固醇的使用非常重要。
