Clinical evaluation of acyclovir in the treatment of ulcerative herpetic keratitis.

For treatment of herpetic keratitis, 5-iodo-2'-deoxyuridine (IUdR) has been the only drug available in Japan. However, IUdR is not completely satisfactory, and alternative antivirals are required. The Association for Research in Infectious Diseases of the Eye, Japan, carried out a clinical trial in 92 cases of ulcerative herpetic keratitis using 3 percent acyclovir ophthalmic ointment to determine its efficacy and safety. In 63 eyes, it had an excellent effect and ulcers healed within seven days. In 26 eyes, it had a good effect and ulcers healed within 14 days or became half-size within seven days. Therefore, the response to acyclovir in 96.8 percent of cases was excellent or good. The average healing time in 81 eyes in which ulcers disappeared within 14 days was 5.8 +/- 3.4 days. Including the five eyes in which ulcers took more than 14 days to heal, the average healing time of ulcers was 6.6 +/- 4.8 days. Of the 92 patients treated with acyclovir ointment, one had contact blepharoconjunctivitis and another complained of mild irritation. Mild punctate keratitis, as another side effect of acyclovir ointment, was observed in 22 eyes (23.9 percent) by photo-slit lamp examination, but in these patients it was possible to continue treatment without complaint.