Current clinical practice of consultant ophthalmologists in treating herpetic eye disease in the United Kingdom

Abstract

Purpose

Herpes simplex virus continues to be a leading cause of chronic corneal opacification and unilateral blindness. No similar studies have been previously conducted in the United Kingdom.

Methods

A 12-question circular was posted to 903 consultant ophthalmologists. It evaluated treatment pattern of primary and recurrent epithelial and stromal keratitis.

Results

Treatment strategies were more uniform than expected, agreeing with Herpetic Eye Disease Study guidelines in the treatment of epithelial and stromal keratitis, but showing deviation in the use of antiviral agents for recurrent disease.

Conclusion

The UK clinical practice for treating herpetic eye disease is consistent but deviates from Herpetic Eye Disease Study guidelines in some areas. Increased awareness of HEDS data could address this issue.

Main

Sir,

The management of Herpetic Eye Disease remains challenging despite progress in understanding its pathogenesis and the recommendations of Herpetic Eye Disease Study (HEDS) group.

We sought to evaluate the current management of this condition by sending an anonymous questionnaire to 903 National Health Service consultant Ophthalmologists, throughout the UK in March 2006.¹

We enquired about the treatment of primary epithelial/stromal keratitis, and the use of oral antiviral prophylaxis in patients with recurrent keratitis. Replies including those from a subset of self-described cornea specialists were compared to published HEDS guidelines.

Response rate was 44% (399 out of 903) and 20% of respondents (n=76) had special interest in cornea.

Eighty-nine per cent of consultants use topical antiviral alone for treating epithelial keratitis, whereas a minority also debride the epithelium or use combined oral and topical antiviral. This conforms well to HEDS, which showed that oral aciclovir added to topical trifluridine did not prevent development of stromal disease and iritis in epithelial keratitis.²

Ninety-six per cent of respondents use topical steroid for treatment of stromal keratitis. This was strongly supported by HEDS.³ Topical steroid alone was used by 10 (3%). Ten per cent of all respondents and cornea specialists added oral antiviral to topical steroid and topical antiviral. HEDS guidelines have shown that oral aciclovir gave no additional benefit in treating stromal keratitis, when added to topical steroid and topical trifluridine.⁴

Oral antiviral, for prevention of further episodes, in recurrent epithelial and stromal keratitis was prescribed routinely by only 30% and 48% of all responders, respectively. It was continued for more than 1 year in epithelial and stromal keratitis by 38% and 44% of the consultants in these groups. Unfortunately, this is in contrast to recommendations from HEDS that showed that oral aciclovir 400 mg BD for a year significantly reduces the recurrence and long-term morbidity of both types of keratitis.⁵ However, this figure rose to a majority of 71% among the cornea specialists with at least one-half advocating a long-term regime of at least 12 months.

We hope that dissemination of this information to a wider, general ophthalmic audience will improve the prophylactic management of recurrent Herpetic Eye Disease.