Indian Journal of Ophthalmology

ARTICLES
Year
: 1979  |  Volume : 27  |  Issue : 4  |  Page : 193--194

Ethyl deoxyuridine in the management of herpes simplex keratitis


SRK Malik, S Mitter 
 Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
SRK Malik
Sir Ganga Ram Hospital, New Delhi
India




How to cite this article:
Malik S, Mitter S. Ethyl deoxyuridine in the management of herpes simplex keratitis.Indian J Ophthalmol 1979;27:193-194


How to cite this URL:
Malik S, Mitter S. Ethyl deoxyuridine in the management of herpes simplex keratitis. Indian J Ophthalmol [serial online] 1979 [cited 2020 Feb 23 ];27:193-194
Available from: http://www.ijo.in/text.asp?1979/27/4/193/32624


Full Text

Herpes simplex infection is one of the important causes of corneal blindness. A speci­fic non-toxic antiviral drug has yet not been found for the management of Herpes keratitis.

Of a number of drugs tried experimentally, 5 Iodo-2 deoxyuridine or IDU has been readily available and is popularly in usage for some time now. But due to clinical resistance and inresponsiveness to IDU and certain undesirable side effects, a search for alternative compounds continues.

Recently it has been claimed that the efficacy of 5 Ethyl Deoxyuridine is a better than IDU in control of Herpes infection of the cornea. The purpose of this study has been to evaluate the role of Ethyl Deoxyuridine (Edurid) clinically in the treatment of Herpes Simplex.

 Materials and Methods



22 cases were selected for this study and were divided in two groups:­

(a) Group-I : 8 cases: Previously untreated cases (Fresh cases)

(b) Group-II : 14 cases: Those who had prior treatment with IDU and cautery etc.

Cases in group I had only epithelial defects while Group II included 14 cases which had stromal involve­ment with epithelial lesions and mild iritis.

Out of 22 cases 15 were males and 7 were females. The patients were of various age group with the majority a (16) in the 2nd and 3rd decade.

There was a prior history of high fever in 16 cases of which 10 had severe malaria.

The regimen of treatment instituted was different in the 2 groups. In Group I (the untreated cases): light cautery was done with carbolic acid followed by removal of the loose epithelium. This was followed by the application of 0-5% Edurid (EDU) drops 2 hourly in the eyes as well as vanamycetin (Chloromycetin) drops every 4 hours. This was supplemented by systemic adminis­tration of vitamin C 500 mg. twice a day and neurobion tab. 1 twice a day.

In the Group 11 (those which had prior treatment); the above mentioned treatment was additionally supple­mented by steroid-antibiotic drops and steroid by mouth (initially one tablet three times a day then in reducing doses). One subconjunctival injection of Edurid 0.5 cc. of 0.5% sterile solution was given for 3 days.

Results

In Group I, all cases responded very well to the treatment and the healing of the ulcer was rapid leaving a very fine nebular opacity within 8-10 days of institution of the treatment.

Of the 14 cases of group II, 6 cases responded excellently with healing of the ulcer in 10 to 12 days, whereas 4 cases showed a slight delay in response i.e., 14-20 days. The remaining 4 showed no improvement and required a penetrating corneal graft. The 10 cases which responded also required grafts later; deep lamellar graft in 8 and penetrating grafts in 2.

In all the cases, there was no evidence of any tissue toxicity due to Ethyl-deoxyuridine as had been seen by Iodo-deoxyuridine.

 Discussion



It has been known that 5 Ethyl-deoxyuridine readily replaces thymidine (5-Methyldeoxyuri­dine) in bacteriophage DNA. These are expected to exhibit the same base-pairing proper proper­ties as the parent compounds, that is, uracil, thymine and their glycosides.

On the other hand, certain pyrimidine nucleosides (e.g. IDU) have a!so proved effective anti-viral agents. However, the incorporation IDU into DNA of normal uninfected cells is mostly responsible for the toxicity that has been found during either topical or systemic therapy.

To summarise the advantages of ED U over ID U as reported after experimentation by K.K. Gauri et al.[1]

(i) Reliably virostatic without irritating the eye.

(ii) Non-mutagenic, therefore long term application is possible.

(iii) No immuno-suppressive action.

(iv) No retardation in the regeneration of affected cornea.

(v) No activation of reverse transcriptase and therefore it has no econgenic effect.

Remarkable virostatic effect of EDU against herpes virus has been demonstrated in experi­mental work. Therapeutic success with EDU has been proved to begin at an earlier time, and to be more durable than with IDU. In fact, some dendritic ulcers have been seen to appear in some cases, 21 days after treatment with IDU has been stopped.

Tissue compatibility:-Experimental studies by E. Riehnn, K.K. Gauri and W. de Decker have shown that:-(a) Injury to stroma and epithelium, after cauterising the cornea of healthy rabbits, heals rapidly and equally well under the influence of EDU and 0.9 sodium chlrodie solution, whereas regeneration gets obviously delayed by IDU.

These experimental results seem to be supported by excellant results of the present study on the merit of EDU in treatment of herpetic keratitis. In our series EDU has shown excellent in early cases. Even in late cases 71-5% responded to treatment though they needed larger treatment and required kerato­plasty for optic purpose. Results of our studies have shown no side effect of prolong use of E.D.U.

 Summary



A clinical study was conducted to assess the efficacy of EDU as anti-viral agent in the treatment of Herpes Simplex keratitis.

E.D.U. was found to be very effective drug in early cases of corneal Herpes. 71.5% of later cases also responded to EDU therapy. There were no side effect of EDU therapy.[2]

References

1K.K. Gauri and W. De Decker, Talk in 121st Assembly of the Verein Rheinisch-Westfalischer Augenorzte in Dusseldorf April, 26th, 1970.
2Kunkul, Gauri and Malormy, 1968, Biophysik, 5, Leaflet 1.