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

Abstract

To compare topical cyclosporine-A 2% eye drop (Cs-A) with prednisolone acetate 1% eye drop for treatment of herpetic stromal keratitis (HSK). 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 400mg twice a day. Slit-lamp examination, Scheimpflug tomography corneal optical densitometry (Pentacam®, Oculus Inc., Wetzlar, Germany), best-corrected visual acuity (BCVA), and intra-ocular pressure (IOP) were evaluated at the first visit, and 14 and 30days after the treatment. Within-group analysis revealed significant improvement of total cornea optical density after 30days 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 30days 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. Cs-A 2% and prednisolone acetate 1% topical eye drops are effective for treatment of HSK.