HEDS Findings

Several interesting findings resulted in changes in the way we manage ocular HSV infections.

• Epithelial disease does not make future recurrences more likely, but stromal disease definitely does.
• Epithelial disease was equally likely in those without previous episodes and those with past episodes.
• Stromal disease was 8 to 10 times more likely over an 18-month study period in those with previous stromal episodes. The greater the number of previous episodes, the greater the risk.
• Stromal disease can occur in the absence of previous epithelial lesions.
• 400 mg of oral Acyclovir (Famvir not studied) twice per day for one year resulted in a 45% decrease in the rate of recurrence for all forms of ocular complications. Over the six months after discontinuation, there was no rebound increase but no continued benefit. Interestingly, the benefit only applied to those with previous stromal disease, not previous dendrites alone!
• Oral Acyclovir did not improve outcomes in cases of stromal keratitis, with the possible exception of necrotizing disease (small sample).
• Steroids were very effective in managing stromal infections and did not increase the rate of recurrence.
• Oral Acyclovir may benefit HSV iridocyclitis (small sample size).
• Treatment of patients with epithelial dendrites with oral Acyclovir does not reduce the rate of stromal disease or iritis.