Reviews Supplements Bausch + Lomb Zirgan : Page 1

Fighting the Battle Against Herpetic Keratitis Herpetic keratitis is hardly a common infection, yet it’s the leading cause of infectious corneal blindness in America. 1 I have a referral practice for ocular infections, so I see the disease fairly frequently — new, acute cases once per month, established cases with acute flare-ups once a week, and follow-up visits for cases in remission multiple times per week. However, the comprehensive ophthalmologist or optometrist may see only a few cases per year. It’s a challenging disease because it can be sight-threatening and it behaves unpredictably. It’s not easy to know when and where flare-ups will occur. In most cases, patients seek help early for outbreaks, which is especially important when the lesion is centrally located and portends significant vision loss if untreated (Figure 1). Once the patient is under our care, antiviral drugs provide a first-line defense. Recommendations for Managing Herpetic Keratitis Patients 3 If significant inflammation is present, treat it with a corticosteroid after the virus is eradicated. Use oral antivirals for deeper infections and herpetic uveitis. Prompt treatment of recurrences is important; common symptoms of herpetic keratitis are photophobia, pain, redness, and a clear discharge. Help patients avoid outbreaks by educating them about triggers such as fever, psychological stress, trauma, and local or systemic medications. Acute Axial Herpetic Keratitis In a typical case of acute para-axial keratitis, a patient goes to the emergency department with a painful red eye. The emergency department doctor thinks that since the patient’s vision is OK, the diagnosis must be bacterial conjunctivitis, and it’s best to prescribe erythromycin ointment and advise the patient to make an appointment with an eye care provider. One to 5 days later, the concerned patient comes into our office in the same condition. The exam shows a fine haziness that is localized to one region of the cornea. In addition to the dendritic defect in the epithelium, axial stromal haze is present, and vision is worse. Peripheral vision has clouded, and central vision has dropped 1 or 2 lines to 20/50 to 20/80, even if the keratitis is superficial. In my experience, roughly half of the cases that are like this one also have an inflammatory response beyond the epithelium, which is especially likely after a delay in treatment. A key to battling the infection is to treat it with a potent and specific preserved topical antiviral. (dendritic ulcers). One drop of ZIRGAN ® can be instilled in the affected eye 5 times per day (approximately every 3 hours when awake) until the corneal ulcer heals, and then 1 drop 3 times per day for 7 days. 2 The drops are preserved with BAK, a non-mercurial preservative. This antiviral has been proven effective and specific to virus-infected cells. 2 In 3 randomized, single-masked, controlled, multicenter clinical trials, which enrolled 213 total patients, ZIRGAN ® was non-inferior to acyclovir ophthalmic ointment 3% in patients with dendritic ulcers. 2 Clinical resolution (healed ulcers) at day 7 was achieved in 72% (41/57) for ZIRGAN ® vs 69% (34/49) for acyclovir (difference 2.5%, 95% CI -15.6% to 20.9%). 2 Indication ZIRGAN ® (ganciclovir ophthalmic gel) 0.15% is a topical ophthalmic antiviral that is indicated for the treatment of acute herpetic keratitis (dendritic ulcers). Important Risk Information about ZIRGAN ® ZIRGAN ® is indicated for topical ophthalmic use only. Patients should not wear contact lenses if they have signs or symptoms of herpetic keratitis or during the course of therapy with ZIRGAN ® . Most common adverse reactions reported in patients were blurred vision (60%), eye irritation (20%), punctate keratitis (5%), and conjunctival hyperemia (5%) . Safety and efficacy in pediatric patients below the age of 2 years have not been established. An Antiviral Option While there are other topical antiviral treatment options from which to select, ZIRGAN ® (ganciclovir ophthalmic gel) 0.15% is a good choice for the treatment of acute herpetic keratitis Please see prescribing information about ZIRGAN ® after this article. 1 ZIRGAN TECHNICAL PAPER

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