|Year : 1981 | Volume
| Issue : 3 | Page : 247-249
Topical cortico-steroid in herpetic keratitis
G Mukherjee, Madan Mohan, SK Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mukherjee G, Mohan M, Angra S K. Topical cortico-steroid in herpetic keratitis. Indian J Ophthalmol 1981;29:247-9
The topical use of corticosteroids in herpes simplex keratitis may be hazardous when usec in normal concentrations (e.g., Decadror 0.1%). Experimental investigations havt shown that when diluted I : 10 or 1 : 2( topical Dexamethasone (0.01-0.005%) ceases tc have adverse effect. A comparative clinical trial with varying strength of Dexamethasone in clinical cases of herpetic keratitis is the subject of this study.
| Materials and methods|| |
GROUP-I. RECURRENT EPITHELIAL KERATITIS
A=Treated with I.D.U. only-11 cases
B=Treated with I.D.U. and topical steroid (1 : 20)-29 cases.
GROUP-II. STROMAL KERATITIS WITH OR WITHOUT EPITHELIAL KERATITIS
A (a)=Stromal with epithelial keratitis-treated with I.D.U. only-5 cases.
A (b) =Stromal keratitis-treated with I.D.U. and cortico steroid (0.1%)-7 cases.
B (a) =Stromal with epithelial keratitis -treated with I.D.U. and cortico steroid (1 : 10) -9 cases
B (b) =Stromal keratitis
-treated with I.D.U. and cortico steroid (I : 10)-12 cases.
GROUP III-I.D.U. TOXICITY CASES TREATED WITH STEROIDS (I : 10)-18 cases.
GROUP IV- KERATOUVEITIS CASES
A-Treated with I.D.U. and cortico steroid -11 cases (0.1 %)
B-Treated with I.D.U. and Cortico Steroid (1 : 10)=14 cases.
TOPICAL THERAPY REGIME
1 . I.D.U. (0.5%) drops hourly or 2 hourly depending on the severity of lesion.
2. Dexamethasone (Decadron) 0.1 drops used 6 hrly. Dilutions used are 1 : 20 for recurrent epithelial keratitis. 1: 10 for other cases
3. Atropine oint. I % H.S. on alternate days in cases of keratouveitis only.
| Observations|| |
Out of 11 cases of recurrent epithelial keratitis (REK) who were on I.D.U. 7 (63.63%) cases had clinical cure with mean healing time of 21.5+1.4 days of which 4 had recurrence. 4 (36.36%) cases had acute exacerbation during therapy and went in to stromal keratitis (SK). 2 cases had secondary bacterial infections. We selected twenty nine cases of REK treated with I.D.U. and Decadron 1 : 20. 26 (89.65%) cases had clinical cure with mean healing time 18.2+0.8 days, and 3 (10.35%) cases had exacerbatior leading to S.K. Two cascs had recurrencf after cessation of therapy. None of the case; had secondary infection.
In the group II A (a) 5 cases of S.K. with epithelial keratitis who were on I.D.U. therapy alone, 2 (40%) cases had initial clinical cure with mean healing time of 24.2±days and both of these cases had recurrence after cessation of therapy. 3 (60%) cases had had exacerbation during therapy, out of which 2 cases had secondary infection. The similar type of 9 cases in group II B (a) when put on I.D.U. local Decadron 1 : 10, 8 (88.88°sub ,0) had clinical cure with mean healing time of 18.1±1.2 days; 1 case had recurrence after cessation of therapy and only 1 (11.12%) case had acute exacerbation during therapy.
7 cases of S.K. in group II A (b), who were on I.D.U. and Decadron, 4 (57.14%) cases showed initial clinical cure with mean healing time of 26.4±1.4 days, 2 cases had recurrence of disease after cessation of therapy. 3 (42.85%) cases had acute exacerbation of which 2 cases had secondary infections. Similar type of 12 cases in group II B (b) when put on IDU drops along with Decadron 1: 10, 11 (91.66,0) cases had clinical cure with mean healing time of 19.4±1.6 days. 2 cases out of 11 cases out of 11 cases have recurrence after cessation of therapy and only 1 (8 34%) case had acute exacerbation. No secondary infections was seen.
We had 18 cases of herpetic keratitis who were on I.D.U. therapy for a length of time and came with repeated superficial punctate keratitis (SPK), diagnosis of I.D.U. toxicity was made. I.D.U. drops were stopped immediately and they were advised to come after 4 days. The residual keratitis was treated after 4 days. The residual keratitis was treated with Decadron in 1 : 10 dilutions. The result 16 (88.8%) had a cure, 2 had exacerbation and I recurrence.
In the last Group IV of keratouveitis, 11 cases who were on I.D.U. therapy alongwith full strength of Decadron (0.2 mg%) drops, 7 (63.63%) cases had initial clinical cure with mean healing time of 26.2±1.4 days, 4 cases came back with recurrence, 3 (27.27%) cases had acute exacerbations, one had secondary infection and other one had corneal perforation. 14 cases of kerato-uveitis treated with I.D.U. alongwith Decadron 1 : 10, 13 cases (92.85%) cases had clinical cure with mean healing time of 23.4±0.9 days, only one case had recurrence after cessation of therapy. One case had exacerbation during therapy and none had complications
| Discussion|| |
It has been shown beyond doubt in experimental animals that the topical application of corticosteroids in herpes simplex keratitis is dose dependent. Angra has shown that while 1 : 5 diluted or full strength of dexamethasone (0.101) drops have statistically significant enhancing effect on herpes simplex virus induced epithelial changes, 1 : 10 or I : 20 diluted dexamethasone (0.1%) drops have no such effect.
Dexamethasone (0.1 %) drops diluted to 1 : 20 when used as adjunct to I.D.U. drops raises the clinical cure rate, reduced the mean healing time, and recurrence rate. We feel that the steroid in low concentration suppress not only the inflammatory reaction but also the immunological reaction at the epithelial level while the healing process as well as viral enhancement is not affected.
Full strength topical steroid used alone or in adjunct to I.D.U. therapy in cases of stromal keratitis with or without epithelial involvement increases exacerbation rate, complications, and recurrences rate.
The epithelial keratopathy, induced by the prolonged use of I.D.U. (0.1%) drops in cases of epithelial keratitis responded well to Dexamethasone (0.1 mg%) drops diluted to 1 : 10. The clinical cure rate increases to 88.88%, with reduced mean healing time. Exacerbation noticed only in two (11.11%) cases. On simple withdraw] of I.D.U. drops the recovery time of punctate epithelial keratitis (PEK) is little more than 3 weeks as reported by Angra 2, while on treatment with diluted (I : 10) dexamethasone reduces the mean healing time to 14 days without any deleterious effect.
| Conclusions|| |
1: 10 and 1: 20 diluted Dexamethasone (0.1 %) has been found to have beneficial effects equivalent to that of full strength of Dexamethasone in controlling corneal inflammations y:t this clinical study seem to confirm the results or certain experimental work.
| References|| |
Angra, S.K., 1976. East. Arch. Ophthalmol 4: 239.
Angra, S.K, 1977, Ind J. Ophthalmol. 25: II : 38.