Acyclovirによる単純ヘルペス性角膜炎の治療

Treatment of herpes simplex keratitis with topical acyclovir

　単純ヘルペス性角膜炎に対するacy-clovir眼軟膏の治療効果を検討した．臨床的に単純ヘルペス性であると診断された角膜潰瘍に対してacyclovirは26眼中24眼（92％）に有効であり，平均潰瘍消失日数は5.2日であった．炎症が実質に波及していないか軽度の12眼では平均消失日数はわずか3.2日であった．IDU耐性と考えられる7眼に対してもacyclovirは有効であった．acyclovirにより治癒した角膜潰瘍患者を追跡調査し再発率を調べた．6カ月後には22％，12カ月後には46％，24カ月後には60％に再発を認めた．再発例に対してもacyclovirは有効で，平均潰瘍消失日数は，6.0日であった．円板状角膜炎6眼に対しacyclovir軟膏とステロイドの併用療法を行った．全例において平均16日で角膜炎の消炎をみた．経過中に上皮性潰瘍の出現はみられなかった．さらに単純ヘルペス性角膜炎の治療に対する現在の我々の考え方を述べた．

We treated 26 eyes in 20 patients with herpetic cor-neal ulcer with 3% acyclovir ointment instilled 5 times a day. The lesions healed in 24 (92%) of the treated eyes within an average of 5.2 days. In 12 eyes with absent or minimal stromal involvement, healing took place within an average of 3.2 days. Acyclovir was effective in 11 eyes which were resistant to prior treatment with IDU.

In 20 patients with HSV keratitis, we found an over-all- predominance of male patients resulting entirely from an increased male-to-female ratio in 10 patients over 40 years of age.

In our prospective study of patients with herpetic corneal ulcer treated with acyclovir, 22% of patients had recurrences within 6 months, 46%within one year and 60% within 2 years. This finding shows that recur-rences cannot be prevented by prior topical acyclovir therapy.

We treated another series of 6 eyes with stromal herpes simplex keratitis by 3% acyclovir ointment and topical corticosteroid. All the eyes were cured after an average of 16 days.

No serious side effects of acyclovir were noted throughout the present study.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(8) : 980-984, 1986