Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022568 (keratitis)
 5,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Idoxuridine which was first used in 1960 (Kaufman et al., 1962), has been for many years the only antiviral agent available in the treatment of herpetic keratitis. It is however no more successful than is mechanical removal of diseased epithelium (Patterson & Jones, 1967), and furthermore it may give rise to serious toxic side effects. The search for an alternative medication is therefore a pressing one. Trifluorothymidine (F3T) has, in recent years, been shown to be more effective than IDU and to be free from significant toxicity. Both of these drugs are pyrimidine nucleosides. Adenine Arabinoside or Arabinoside-A (Ara-A) is, by contrast, a purine nucleoside. It is thought to exert its antiviral effect by blocking DNA polymerase and ribonucleotide reductase.
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PMID:Treatment of herpetic keratitis. 41 44

The efficacy of trifluorothymidine was compared with idoxuridine on a blind basis by noting the effect of topical administration of the drugs on the severity of vaccinial keratitis induced in rabbits. Trifluorothymidine was found to be substantially more effective, and was well tolerated. In addition, positive viral cultures after the treatment period were substantially reduced in the trifluorothymidine groups when compared with the idoxuridine or control groups.
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PMID:Treatment of Vaccinial keratitis with trifluorothymidine. 82 31

The present paper reviews the adverse side effects caused by topically applied antiviral agents in herpetic keratitis. The effective treatment of herpetic keratitis with IDU, a chemotherapeutic agent, was first reported in 1962. After its introduction into ophthalmic therapy for herpetic keratitis, drops of IDU were administered every hour by day combined with ointment every two hours by night. The therapy often continued for months or in some cases, even more than one year. Numerous reports on its side effects have appeared. The side effects can be classified into two categories. The first category is allergic contact blepharodermatitis, a type IV delayed hypersensitivity reaction. Its occurrence is difficult to foresee. This category I side effect rarely results in the destruction of the ocular tissues. The second category of side effects is a drug-induced toxic side effect resulting in punctate epithelial keratitis, papillary conjunctivitis or follicular hypertrophy and lacrimal punctal obstruction. After withdrawal of IDU, these ill effects usually subside soon. When IDU is further continued, the destructive change of the tissues will ensue. Conjunctival cicatrization, symblepharon, corneal neovascularization, cicatrization and irreversible punctal occlusion have been reported in cases with prolonged IDU treatment. In addition to IDU for therapy of herpetic keratitis, we are fortunate to have F3T, Ara-A and acyclovir. They show no cross sensitivity reaction nor any cross toxic reaction to each other. However, if administered more than several times daily and continued for a prolonged period of time, these antiviral agents, like IDU, can also result in reversible side effects and, further, irreversible tissue destruction. Conjunctival cicatrization and permanent punctal occlusion caused by prolonged administration of F3T have been reported. Prompt recognition of the untoward reactions and withdrawal of the antiviral agent will result in the subsidence of the toxic reaction changes and prevent the eye from irreversible destruction. The recognition, prevention and management of the untoward side effects also are discussed.
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PMID:[Adverse side effects caused by topically applied antiviral agents in herpetic keratitis]. 248 Apr 57

Conjunctivitis has many bacterial and viral causes. If the cause is bacterial, treatment with a broad-spectrum antibiotic resolves the problem in 1 to 3 days in almost all cases. If signs and symptoms persist, referral to an ophthalmologist is wise. Most cases of viral conjunctivitis are accompanied by follicular reactions in the inferior fornix, as observed with adult inclusion disease. If dendrites are seen, trifluridine (Viroptic) is preferred for treatment. Referral to an ophthalmologist is advisable because recurrence with scarring and permanent loss of vision is possible. Many topical antibiotics include a corticosteroid component that never should be used unless the conjunctivitis or keratitis is proven to be nonherpetic.
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PMID:Viral and bacterial conjunctivitis. Prevention of disastrous results. 278 Apr 35

Trifluridine (TFT) and a structurally related analogue, 5-fluoro-2'-deoxyuridine (FDU), were investigated for their efficacy in the topical treatment of experimental keratitis caused by thymidine kinase-positive (TK+) and thymidine kinase-deficient (TK-) herpes simplex virus type 1 (HSV-1) strains. Bromovinyldeoxyuridine (BVDU) was used as a reference compound. Both 0.2% BVDU and 0.2% TFT eyedrops produced a highly significant healing of TK+HSV-1 keratitis as compared to the placebo and 0.2% FDU eyedrops (P much less than 0.005), whereas the latter compound did not differ from placebo eyedrops. In the treatment of TK HSV-1 keratitis, none of the drugs exhibited a beneficial healing effect, although the virus strain used was inhibited in vitro by TFT and FDU at a very low concentration (0.02-0.04 microgram/mL).
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PMID:Experimental thymidine kinase-deficient HSV-1 keratitis: therapeutic attempts. 295 58

The present study examined the antiherpetic effect of 2'-nor-cGMP, a new cyclic phosphate derivative of 2'NDG, in vitro and in the mouse keratitis model. The 50% inhibitory dose (ID50) was determined with HSV-1 RE strain in Vero cell monolayers for 2'-nor-cGMP (6.9 mcg./ml), 2'NDG (.06 mcg/ml), and trifluridine (F3T) (.72 mcg/ml). Balb C mice underwent bilateral ocular inoculation with HSV-1 RE strain, and then were treated with different therapeutic regimens. The antiviral efficacy of each drug was evaluated by ocular virus titers, clinical grading of epithelial keratitis, and histological evaluation of stromal keratitis. 2'-nor-cGMP was the most effective drug (P = .0001) in reducing ocular viral titers. Both 2'-nor-cGMP and 2'NDG were significantly more effective (P = .0001) than F3T in reducing epithelial keratitis, and as effective as F3T in reducing stromal keratitis.
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PMID:2'-nor-cGMP, a new cyclic derivative of 2'NDG, inhibits HSV-1 replication in vitro and in the mouse keratitis model. 303 Jun 46

Various side effects due to antiherpetic drugs observed in the last ten years in our department were studied. A total of 132 patients were treated with 5-iodo-2'-deoxyuridine (IDU), 69 with trifluorothymidine (F3T), 58 with acyclovir (ACV) and 33 with adenine arabinoside (ara-A). Patch tests were routinely done when patients exhibited contact dermatitis. Of the patients treated with IDU, 3 (2.3%) showed contact dermatitis, 2 (1.5%) follicular conjunctivitis and 1 (0.8%) punctate keratopathy. Of the patients treated with F3T, 7 (10.1%) exhibited contact dermatitis and 1 (1.4%) follicular conjunctivitis. In the group treated with ACV, 2 (3.4%) patients showed punctate keratopathy. The patients who received ara-A did not show any side effects. We found that F3T caused contact dermatitis more frequently in Japanese people than Europeans. These side effects were resolved by switching to another anti-herpetic drug without the occurrence of cross-allergy. Therefore, switching to another drug is strongly recommended when patients exhibit side effects in the treatment of herpetic keratitis. Other complications were allergy to atropine and to drug preservative.
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PMID:Side effects in the treatment of herpetic keratitis. 310 84

Trifluridine (trifluorothymidine) is an antiviral agent for topical use in the eye, and is structurally related to idoxuridine. In vitro studies have shown that it effectively inhibits the replication of herpes simplex virus type 1, which causes primary keratoconjunctivitis and recurrent epithelial keratitis in man. In masked comparative studies, predominantly in patients with dendritic ulcers, trifluridine 1% solution was effective in over 90% of patients; in such studies it was comparable with vidarabine in treating dendritic ulcers, and was at least as effective as, and in some studies more effective than, idoxuridine. The drug was also effective in treating a small number of patients with geographic ulcers (sometimes associated with the usage of topical corticosteroids), and this could be an important advantage if confirmed in further well-designed studies. However, experience at present is too limited to reliably determine the usual response rate in this difficult therapeutic area. In open studies the drug proved to be particularly useful in treating ulcers previously unresponsive to idoxuridine or vidarabine, and in treating patients intolerant of idoxuridine, with a high success rate and minimal side effects being reported. The role of trifluridine in treating deep stromal disease, uveitis, or adenovirus kerato-conjunctivitis has not been established. The drug is well tolerated and cross-hypersensitivity and cross-toxicity between trifluridine, idoxuridine and vidarabine are rare. Thus, trifluridine is an effective alternative to the drugs available for treating herpetic keratitis, and seems especially useful in 'difficult' cases.
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PMID:Trifluridine: a review of its antiviral activity and therapeutic use in the topical treatment of viral eye infections. 628 70

The treatment of herpetic corneal ulcerations with trifluorthymidine (F3T) has been evaluated in a clinical trial. F3T was found to be an effective antiviral agent for herpetic keratitis and a valuable alternative to idoxuridine (IDU)-therapy. Clinically IDU-resistent herpetic ulcers responded favourably to treatment with F3T.
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PMID:Trifluorthymidine in the treatment of herpes simplex corneal ulcers. A clinical evaluation. 677 92

The efficacy of Aciclovir and Trifluorothymidine (TFT) treatment was tested in a double blind trial of thirty-eight patients with dendritic keratitis. All twenty patients treated with Aciclovir healed within 10 days with an average healing time of 5.0 days. Two of the eighteen patients treated with TFT failed to heal within 22 days, the others healed within ten days, the average healing was 6.6 days. Punctate keratopathy was seen in 70% of both groups. Intense conjunctival hyperaemia developed in two TFT patients.
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PMID:Aciclovir and trifluorothymidine in herpetic keratitis. Preliminary report of a multicentered trial. 678 59


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