Topical cyclosporine-A versus prednisolone for herpetic stromal keratitis: a randomized controlled trial

Abstract

PURPOSE: To compare topical cyclosporine-A 2 eye drop (Cs-A) with prednisolone acetate 1 eye drop for treatment of herpetic stromal keratitis (HSK). METHODS: In this randomized clinical trial, 38 eyes of 33 patients with HSK were randomly assigned to receive either 2 Cs-A or 1 prednisolone acetate eye drops. All subjects received oral acyclovir 400 mg twice a day. Slit-lamp examination, Scheimpflug tomography corneal optical densitometry (Pentacam(R), Oculus Inc., Wetzlar, Germany), best-corrected visual acuity (BCVA), and intra-ocular pressure (IOP) were evaluated at the first visit, and 14 and 30 days after the treatment. RESULTS: Within-group analysis revealed significant improvement of total cornea optical density after 30 days of treatment in both groups (30.3 +/- 10.5 to 28.3 +/- 9.8, p < 0.001 for prednisolone group, and 30.5 +/- 8.8 to 28.8 +/- 8.3 p < 0.001 for Cs-A group, mean +/- SD). We were not able to disclose any significant difference between the two groups regarding the improvement of cornea optical density (p = 0.66). Best-corrected visual acuity (BCVA) logMAR significantly improved in both groups after 30 days of treatment (0.20 +/- 0.52, p = 0.002 in prednisolone group, and 0.24 +/- 0.31, p < 0.001 in Cs-A group, mean +/- SD). Analysis between groups did not show a significant difference of BCVA improvement (p = 0.45). We did not observe any severe side effect attributable to drugs. CONCLUSIONS: Cs-A 2 and prednisolone acetate 1 topical eye drops are effective for treatment of HSK.