ARTICLE Effect of Oral Valaciclovir on Herpetic Keratitis

Purpose: To examine the efficacy of valaciclovir (VACV) oral formulation as an alternative to topical treatments in a case of herpetic keratitis. Methods: The patient was a 61-year-old man who presented with dendritic keratitis in his left eye. After recognizing his difficulty in using eye ointment, we prescribed oral VACV 500 mg tablets twice daily for 7 days. We also describe our experiments with orally admini-stered VACV in a mouse model of this disease. In this study, 143 Balb/c mice were inoculated with herpes simplex virus type 1 (HSV)-1 in each eye and treated with oral VACV 50 or 100 mg/kg twice daily, oral acyclovir (ACV) 50 mg/kg 5 times/d, 3 % ACVeye ointment (ACV-O) 5 times/d, 3 % ACV eye drops 5 times/d, or control for 5 days. Results: After 7 days, the patient’s lesion was observed healed. Corrected left visual acuity was also improved, and HSV DNA was below detectable level. In the mouse study, slit-lamp examination on days 3, 4, 5, and 7 revealed that all 5 ACV and VACV treatment groups were significantly more effective in improving symptoms of herpetic epithelial keratitis versus control (P, 0.05). Moreover, VACV 100 mg/kg was superior to other treatments. Viral titers in mouse eyeball and trigeminal ganglia were lowest in the VACV 100 mg/kg group versus other treatment groups. Conclusion: Our case example suggests that when frequent appli-cation, blurred vision, and foreign body sensation after ACV-O appli-cation cause difficulty for patients to follow treatment, oral VACVmight be an effective and safe option for patients with herpetic keratitis. Key Words: valaciclovir, acyclovir, herpes simplex virus type 1, herpetic keratitis, murine mode