The Experts below are selected from a list of 144 Experts worldwide ranked by ideXlab platform

Kirk R. Wilhelmus - One of the best experts on this subject based on the ideXlab platform.

  • slitlamp biomicroscopy and photographic image analysis of herpes simplex virus stromal keratitis
    Archives of Ophthalmology, 2009
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Peter R. Laibson, Herbert E. Kaufman, Robert A. Hyndiuk, Bruce Barron, Daniel B Jones, Bradley M Mitchell, Doyle R Stulting
    Abstract:

    Objective To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis. Methods Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 Eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation. Results Stromal keratitis had a median area of 22.4 mm2(interquartile range, 12.8-31.6 mm2) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 Eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of Herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02). Conclusions Image analysis validly assesses the disciform geometry of Herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.

  • recall bias in a prospective cohort study of acute time varying exposures example from the Herpetic Eye Disease study
    Journal of Clinical Epidemiology, 2001
    Co-Authors: Kevin E Kip, Kirk R. Wilhelmus, Frances Cohen, Stephen R Cole, Donald L Patrick, Clifford R Blair, Roy W Beck
    Abstract:

    Recall bias is possible in a prospective cohort study when exposure status is transient and must be periodically recalled, and ascertainment occurs after symptom onset. We know of no published demonstration of such bias at play in a prospective cohort study. In a substudy of a randomized clinical trial, 308 participants were prospectively followed to investigate potential acute triggers of ocular herpes simplex virus (HSV) recurrences. Participants reported on the presence of systemic infection or high psychological stress (exposures) on a home log that was completed weekly for up to 15 months and mailed to the study's coordinating centers. By protocol, exposure reporting was to occur on the last day of the week (Sunday) so that a prospective 1-week lag period between exposure and outcome in the following week could be assessed. The study outcome was development of a recurrence of ocular HSV Disease documented by clinical examination. Using 35 weekly reports of exposure properly completed before the week of an outcome, there was no evidence of higher risk of HSV recurrence associated with systemic infection (rate ratio = 0.62, 95% confidence interval [CI]: 0.19-2.02) or high psychological stress rate (ratio = 0.0, 95% CI: 0.0-undefined). In contrast, when the analysis was based on 26 weekly reports of exposure improperly completed on or after the date of outcome, the risk of recurrence associated with systemic infection was estimated to be 4-fold (rate ratio = 4.07, 95% CI: 1.84-8.98), and there was a suggestion of a 2-fold risk associated with high psychological stress (rate ratio = 2.02, 95% CI: 0.69-5.91). Without real-time monitoring of exposure reporting, preservation of the temporal exposure-Disease relationship-an implicit assumption of the prospective cohort study design-may be particularly tenuous when transient exposures are investigated longitudinally.

  • Risk factors for herpes simplex virus epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
    British Journal of Ophthalmology, 1996
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. Laibson
    Abstract:

    AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial Disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.

  • Herpetic Eye Disease study you can help
    Archives of Ophthalmology, 1996
    Co-Authors: Chandler R. Dawson, Kirk R. Wilhelmus, Roy W Beck, Elisabeth J Cohen
    Abstract:

    The TREATMENTof herpes simplex virus (HSV) infections of the Eye has been controversial for many years. One unresolved issue involves the use of corticosteroids in the treatment of HSV stromal keratitis. A second issue relates to the use of the potent antiviral, acyclovir, which has been demonstrated to be effective in preventing recurrences of HSV genital infections. 1 Now the results of two placebo-controlled therapeutic trials have addressed these two issues in the management of herpes simplex Eye Disease. 2,3 TOPICAL CORTICOSTEROIDS FOR HSV STROMAL KERATITIS To evaluate topical corticosteroids, nine clinical centers in the United States recruited 106 patients with active HSV stromal keratitis, no epithelial defect, and no steroid treatment for at least 10 days. 2 Forty-nine patients were randomized to treatment with placebo and 57 patients to topical prednisolone phosphate drops. In a standardized regimen, the prednisolone (and placebo) drops were progressively decreased over a 10-week

  • Herpetic Eye Disease study a controlled trial of oral acyclovir for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Bruce Barron, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Kirk R. Wilhelmus, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus (HSV) in patients receiving concomitant topical corticosteroids and trifluridine. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter trial in 104 patients with HSV stromal keratitis without accompanying HSV epithelial keratitis. Sample size was chosen so that a 5%, one-tailed test would have an 80% chance of detecting a doubling of the median time to treatment failure. Patients were randomized to receive a 10-week course of either oral acyclovir (400 mg 5 times daily, n=51) or placebo (n = 53). All patients also received a standard regimen of topical prednisolone phosphate and trifluridine. Ophthalmologic examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 6 months after entry into the trial. Results: The median time to treatment failure (defined as worsening or no improvement of stromal keratitis or an adverse event) was 84 days (95% confidence interval, 69-93 days) for the acyclovir group and 62 days (95% confidence interval, 57-90 days) for the placebo group. By 16 weeks, 38 patients (75%) in the acyclovir group and 39 patients (74%) in the placebo group had failed treatment. Also by that time, the keratitis had resolved with trial medications, and there was no subsequent worsening in nine patients (18%) in the acyclovir group and ten (19%) in the placebo group. None of these results were significantly different between the two groups. However, visual acuity improved over 6 months in significantly more patients in the acyclovir group than in the placebo group. Conclusion: There was no statistically or clinically significant beneficial effect of oral acyclovir in treating HSV stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine with regard to time to treatment failure, proportion of patients who failed treatment, proportion of patients whose keratitis resolved, time to resolution, or 6-month best-corrected visual acuity. Visual acuity improved over 6 months in more patients in the acyclovir group than in the placebo group.

Robert A. Hyndiuk - One of the best experts on this subject based on the ideXlab platform.

  • slitlamp biomicroscopy and photographic image analysis of herpes simplex virus stromal keratitis
    Archives of Ophthalmology, 2009
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Peter R. Laibson, Herbert E. Kaufman, Robert A. Hyndiuk, Bruce Barron, Daniel B Jones, Bradley M Mitchell, Doyle R Stulting
    Abstract:

    Objective To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis. Methods Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 Eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation. Results Stromal keratitis had a median area of 22.4 mm2(interquartile range, 12.8-31.6 mm2) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 Eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of Herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02). Conclusions Image analysis validly assesses the disciform geometry of Herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.

  • Risk factors for herpes simplex virus epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
    British Journal of Ophthalmology, 1996
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. Laibson
    Abstract:

    AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial Disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.

  • Herpetic Eye Disease study a controlled trial of oral acyclovir for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Bruce Barron, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Kirk R. Wilhelmus, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus (HSV) in patients receiving concomitant topical corticosteroids and trifluridine. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter trial in 104 patients with HSV stromal keratitis without accompanying HSV epithelial keratitis. Sample size was chosen so that a 5%, one-tailed test would have an 80% chance of detecting a doubling of the median time to treatment failure. Patients were randomized to receive a 10-week course of either oral acyclovir (400 mg 5 times daily, n=51) or placebo (n = 53). All patients also received a standard regimen of topical prednisolone phosphate and trifluridine. Ophthalmologic examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 6 months after entry into the trial. Results: The median time to treatment failure (defined as worsening or no improvement of stromal keratitis or an adverse event) was 84 days (95% confidence interval, 69-93 days) for the acyclovir group and 62 days (95% confidence interval, 57-90 days) for the placebo group. By 16 weeks, 38 patients (75%) in the acyclovir group and 39 patients (74%) in the placebo group had failed treatment. Also by that time, the keratitis had resolved with trial medications, and there was no subsequent worsening in nine patients (18%) in the acyclovir group and ten (19%) in the placebo group. None of these results were significantly different between the two groups. However, visual acuity improved over 6 months in significantly more patients in the acyclovir group than in the placebo group. Conclusion: There was no statistically or clinically significant beneficial effect of oral acyclovir in treating HSV stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine with regard to time to treatment failure, proportion of patients who failed treatment, proportion of patients whose keratitis resolved, time to resolution, or 6-month best-corrected visual acuity. Visual acuity improved over 6 months in more patients in the acyclovir group than in the placebo group.

  • Herpetic Eye Disease study a controlled trial of topical corticosteroids for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Bruce Barron, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of topical corticosteroids in treating herpes simplex stromal keratitis. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter clinical trial of 106 patients with active herpes simplex stromal keratitis who had not received any corticosteroids for at least 10 days before study enrollment. Patients were assigned to the placebo group (n = 49) or the steroid group (topical prednisolone phosphate; n=57); both regimens were tapered over 10 weeks. Both groups received topical trifluridine. Visual acuity assessment and slit-lamp biomicroscopy were performed weekly for 10 weeks, every other week for an additional 6 weeks or until removal from the trial, and at 6 months after randomization. Results: The time to treatment failure (defined by specific criteria as persistent or progressive stromal keratouveitis or an adverse event) was significantly longer in the steroid group compared with the placebo group. Compared with placebo, corticosteroid therapy reduced the risk of persistent or progressive stromal keratouveitis by 68%. The time from randomization to resolution of stromal keratitis and uveitis was significantly shorter in the steroid group compared with the placebo group even though both groups included patients who were removed from the study and treated with topical corticosteroids according to best medical judgment. Nineteen (33%) of the steroid-treated patients and 11(22%) of the placebo-treated patients completed the 10 weeks of protocol therapy and had stable, noninflamed corneas after 16 weeks. At 6 months after randomization, no clinically or statistically significant differences in visual outcome or recurrent Herpetic Eye Disease were identified between the steroid and placebo groups. Conclusions: The topical corticosteroid regimen used in this study was significantly better than placebo in reducing persistence or progression of stromal inflammation and in shortening the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but had no detrimental effect as assessed by visual outcome at 6 months.

Chandler R. Dawson - One of the best experts on this subject based on the ideXlab platform.

  • slitlamp biomicroscopy and photographic image analysis of herpes simplex virus stromal keratitis
    Archives of Ophthalmology, 2009
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Peter R. Laibson, Herbert E. Kaufman, Robert A. Hyndiuk, Bruce Barron, Daniel B Jones, Bradley M Mitchell, Doyle R Stulting
    Abstract:

    Objective To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis. Methods Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 Eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation. Results Stromal keratitis had a median area of 22.4 mm2(interquartile range, 12.8-31.6 mm2) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 Eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of Herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02). Conclusions Image analysis validly assesses the disciform geometry of Herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.

  • Risk factors for herpes simplex virus epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
    British Journal of Ophthalmology, 1996
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. Laibson
    Abstract:

    AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial Disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.

  • Herpetic Eye Disease study you can help
    Archives of Ophthalmology, 1996
    Co-Authors: Chandler R. Dawson, Kirk R. Wilhelmus, Roy W Beck, Elisabeth J Cohen
    Abstract:

    The TREATMENTof herpes simplex virus (HSV) infections of the Eye has been controversial for many years. One unresolved issue involves the use of corticosteroids in the treatment of HSV stromal keratitis. A second issue relates to the use of the potent antiviral, acyclovir, which has been demonstrated to be effective in preventing recurrences of HSV genital infections. 1 Now the results of two placebo-controlled therapeutic trials have addressed these two issues in the management of herpes simplex Eye Disease. 2,3 TOPICAL CORTICOSTEROIDS FOR HSV STROMAL KERATITIS To evaluate topical corticosteroids, nine clinical centers in the United States recruited 106 patients with active HSV stromal keratitis, no epithelial defect, and no steroid treatment for at least 10 days. 2 Forty-nine patients were randomized to treatment with placebo and 57 patients to topical prednisolone phosphate drops. In a standardized regimen, the prednisolone (and placebo) drops were progressively decreased over a 10-week

  • Herpetic Eye Disease study a controlled trial of oral acyclovir for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Bruce Barron, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Kirk R. Wilhelmus, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus (HSV) in patients receiving concomitant topical corticosteroids and trifluridine. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter trial in 104 patients with HSV stromal keratitis without accompanying HSV epithelial keratitis. Sample size was chosen so that a 5%, one-tailed test would have an 80% chance of detecting a doubling of the median time to treatment failure. Patients were randomized to receive a 10-week course of either oral acyclovir (400 mg 5 times daily, n=51) or placebo (n = 53). All patients also received a standard regimen of topical prednisolone phosphate and trifluridine. Ophthalmologic examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 6 months after entry into the trial. Results: The median time to treatment failure (defined as worsening or no improvement of stromal keratitis or an adverse event) was 84 days (95% confidence interval, 69-93 days) for the acyclovir group and 62 days (95% confidence interval, 57-90 days) for the placebo group. By 16 weeks, 38 patients (75%) in the acyclovir group and 39 patients (74%) in the placebo group had failed treatment. Also by that time, the keratitis had resolved with trial medications, and there was no subsequent worsening in nine patients (18%) in the acyclovir group and ten (19%) in the placebo group. None of these results were significantly different between the two groups. However, visual acuity improved over 6 months in significantly more patients in the acyclovir group than in the placebo group. Conclusion: There was no statistically or clinically significant beneficial effect of oral acyclovir in treating HSV stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine with regard to time to treatment failure, proportion of patients who failed treatment, proportion of patients whose keratitis resolved, time to resolution, or 6-month best-corrected visual acuity. Visual acuity improved over 6 months in more patients in the acyclovir group than in the placebo group.

  • Herpetic Eye Disease study a controlled trial of topical corticosteroids for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Bruce Barron, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of topical corticosteroids in treating herpes simplex stromal keratitis. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter clinical trial of 106 patients with active herpes simplex stromal keratitis who had not received any corticosteroids for at least 10 days before study enrollment. Patients were assigned to the placebo group (n = 49) or the steroid group (topical prednisolone phosphate; n=57); both regimens were tapered over 10 weeks. Both groups received topical trifluridine. Visual acuity assessment and slit-lamp biomicroscopy were performed weekly for 10 weeks, every other week for an additional 6 weeks or until removal from the trial, and at 6 months after randomization. Results: The time to treatment failure (defined by specific criteria as persistent or progressive stromal keratouveitis or an adverse event) was significantly longer in the steroid group compared with the placebo group. Compared with placebo, corticosteroid therapy reduced the risk of persistent or progressive stromal keratouveitis by 68%. The time from randomization to resolution of stromal keratitis and uveitis was significantly shorter in the steroid group compared with the placebo group even though both groups included patients who were removed from the study and treated with topical corticosteroids according to best medical judgment. Nineteen (33%) of the steroid-treated patients and 11(22%) of the placebo-treated patients completed the 10 weeks of protocol therapy and had stable, noninflamed corneas after 16 weeks. At 6 months after randomization, no clinically or statistically significant differences in visual outcome or recurrent Herpetic Eye Disease were identified between the steroid and placebo groups. Conclusions: The topical corticosteroid regimen used in this study was significantly better than placebo in reducing persistence or progression of stromal inflammation and in shortening the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but had no detrimental effect as assessed by visual outcome at 6 months.

Peter R. Laibson - One of the best experts on this subject based on the ideXlab platform.

  • slitlamp biomicroscopy and photographic image analysis of herpes simplex virus stromal keratitis
    Archives of Ophthalmology, 2009
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Peter R. Laibson, Herbert E. Kaufman, Robert A. Hyndiuk, Bruce Barron, Daniel B Jones, Bradley M Mitchell, Doyle R Stulting
    Abstract:

    Objective To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis. Methods Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 Eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation. Results Stromal keratitis had a median area of 22.4 mm2(interquartile range, 12.8-31.6 mm2) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 Eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of Herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02). Conclusions Image analysis validly assesses the disciform geometry of Herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.

  • the impact of the Herpetic Eye Disease studies on the management of herpes simplex virus ocular infections
    Current Opinion in Ophthalmology, 1999
    Co-Authors: Sudha Sudesh, Peter R. Laibson
    Abstract:

    Herpes simplex virus (HSV) is a leading cause of chronic infectious ocular Disease in the United States. The morbidity from recurrent Herpetic episodes is high, and the resultant corneal scarring may require penetrating keratoplasty for visual rehabilitation. Effective treatments for acute episodes of HSV have been verified by early Herpetic Eye Disease Study (HEDS) trials. The recent HEDS trial on the efficacy of oral acyclovir as prophylaxis against recurrent stromal keratitis represents the first report of a treatment likely to reduce long-term scarring from Herpetic Disease. This article reviews all the HEDS trials and the implications of their findings for the management of patients with ocular HSV.

  • Risk factors for herpes simplex virus epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
    British Journal of Ophthalmology, 1996
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. Laibson
    Abstract:

    AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial Disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.

Herbert E. Kaufman - One of the best experts on this subject based on the ideXlab platform.

  • slitlamp biomicroscopy and photographic image analysis of herpes simplex virus stromal keratitis
    Archives of Ophthalmology, 2009
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Peter R. Laibson, Herbert E. Kaufman, Robert A. Hyndiuk, Bruce Barron, Daniel B Jones, Bradley M Mitchell, Doyle R Stulting
    Abstract:

    Objective To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis. Methods Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 Eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation. Results Stromal keratitis had a median area of 22.4 mm2(interquartile range, 12.8-31.6 mm2) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 Eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of Herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02). Conclusions Image analysis validly assesses the disciform geometry of Herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.

  • Risk factors for herpes simplex virus epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
    British Journal of Ophthalmology, 1996
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. Laibson
    Abstract:

    AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal keratitis and/or iridocyclitis without epithelial Disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial keratitis and non-white patients were more likely to develop HSV epithelial keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial keratitis and certain ethnic groups may have a higher rate of recurrent epithelial keratitis during the acute treatment of HSV stromal keratouveitis.

  • Herpetic Eye Disease study a controlled trial of oral acyclovir for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Bruce Barron, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Kirk R. Wilhelmus, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus (HSV) in patients receiving concomitant topical corticosteroids and trifluridine. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter trial in 104 patients with HSV stromal keratitis without accompanying HSV epithelial keratitis. Sample size was chosen so that a 5%, one-tailed test would have an 80% chance of detecting a doubling of the median time to treatment failure. Patients were randomized to receive a 10-week course of either oral acyclovir (400 mg 5 times daily, n=51) or placebo (n = 53). All patients also received a standard regimen of topical prednisolone phosphate and trifluridine. Ophthalmologic examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 6 months after entry into the trial. Results: The median time to treatment failure (defined as worsening or no improvement of stromal keratitis or an adverse event) was 84 days (95% confidence interval, 69-93 days) for the acyclovir group and 62 days (95% confidence interval, 57-90 days) for the placebo group. By 16 weeks, 38 patients (75%) in the acyclovir group and 39 patients (74%) in the placebo group had failed treatment. Also by that time, the keratitis had resolved with trial medications, and there was no subsequent worsening in nine patients (18%) in the acyclovir group and ten (19%) in the placebo group. None of these results were significantly different between the two groups. However, visual acuity improved over 6 months in significantly more patients in the acyclovir group than in the placebo group. Conclusion: There was no statistically or clinically significant beneficial effect of oral acyclovir in treating HSV stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine with regard to time to treatment failure, proportion of patients who failed treatment, proportion of patients whose keratitis resolved, time to resolution, or 6-month best-corrected visual acuity. Visual acuity improved over 6 months in more patients in the acyclovir group than in the placebo group.

  • Herpetic Eye Disease study a controlled trial of topical corticosteroids for herpes simplex stromal keratitis
    Ophthalmology, 1994
    Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Joel Sugar, Herbert E. Kaufman, Bruce Barron, Lauren Gee, Walter W Hauck, Natalie Kurinij, Daniel B Jones, Robert A. Hyndiuk
    Abstract:

    Purpose: To evaluate the efficacy of topical corticosteroids in treating herpes simplex stromal keratitis. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter clinical trial of 106 patients with active herpes simplex stromal keratitis who had not received any corticosteroids for at least 10 days before study enrollment. Patients were assigned to the placebo group (n = 49) or the steroid group (topical prednisolone phosphate; n=57); both regimens were tapered over 10 weeks. Both groups received topical trifluridine. Visual acuity assessment and slit-lamp biomicroscopy were performed weekly for 10 weeks, every other week for an additional 6 weeks or until removal from the trial, and at 6 months after randomization. Results: The time to treatment failure (defined by specific criteria as persistent or progressive stromal keratouveitis or an adverse event) was significantly longer in the steroid group compared with the placebo group. Compared with placebo, corticosteroid therapy reduced the risk of persistent or progressive stromal keratouveitis by 68%. The time from randomization to resolution of stromal keratitis and uveitis was significantly shorter in the steroid group compared with the placebo group even though both groups included patients who were removed from the study and treated with topical corticosteroids according to best medical judgment. Nineteen (33%) of the steroid-treated patients and 11(22%) of the placebo-treated patients completed the 10 weeks of protocol therapy and had stable, noninflamed corneas after 16 weeks. At 6 months after randomization, no clinically or statistically significant differences in visual outcome or recurrent Herpetic Eye Disease were identified between the steroid and placebo groups. Conclusions: The topical corticosteroid regimen used in this study was significantly better than placebo in reducing persistence or progression of stromal inflammation and in shortening the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but had no detrimental effect as assessed by visual outcome at 6 months.

  • design and organization of the Herpetic Eye Disease study heds
    Current Eye Research, 1991
    Co-Authors: Chandler R. Dawson, Herbert E. Kaufman, Bruce Barron, Walter W Hauck, Daniel B Jones, Kirk R. Wilhelmus
    Abstract:

    The Herpetic Eye Disease Study (HEDS) includes three double-masked, placebo-controlled clinical trials for potentially blinding herpes simplex virus (HSV) Eye infections. One study compares a tapering dosage of topical prednisolone or placebo Eye drops for HSV stromal keratitis (HEDS-SKN). Two other trials compare oral acyclovir to placebo capsules for HSV stromal keratitis (HEDS-SKS) or iridocyclitis (HEDS-IRT) in patients on a tapering dosage of topical prednisolone drops. All medications are administered for 10 weeks. Outcome is judged by time to recurrent Disease or treatment failure. This paper presents the design, estimated sample size and recruitment as of July 25, 1990.