[AF] zovirax+cortisona

[Ramon Diaz-Alersi]

Pues sí, los corticoides tópicos están indicados en las ulceraciones
corneales y en la queratitis por virus herpes simplex. Siempre en
combinación con el antiviral, claro. Esto es lo que dice el
"Emedicine":

    * Dendritic, geographic, and marginal corneal ulcers are treated
with the following:

          o Debridement of the infected epithelium. Debridement is
performed after instillation of topical anesthetic (4% cocaine or 0.5%
proparacaine) into the conjunctival sac. The loose epithelium at the
edge of the dendritic figure is wiped away with a sterile
cotton-tipped applicator or with the edge of a knife blade or platinum
spatula.

          o Trifluridine 1% drops, 9 times a day; or vidarabine 3%
ointment, 5 times a day; or 2 g of oral acyclovir once per day

          o Two new antiviral agents, 0.2% cidofovir eye drops and 3%
penciclovir ointment have been effective in the rabbit model in
treating herpetic epithelial keratitis and may have a role in humans
in the future.

          o Cycloplegic agent

          o Topical steroids may be required after several days of
antiviral treatment in patients with marginal ulcers or associated
stromal disease to quell the immune response.

          o The attempt to augment or modify the host's immunologic
milieu has led some investigators to study the role of cimetidine as
an adjunct to standard antiviral therapy. The efficacy of this
modality has not been fully established. In vitro studies using both
fusion proteins (that block the interaction of T cells with
antigen-presenting cells) and basic fibroblastic growth factors have
shown a beneficial effect of these as adjunctive treatments in
decreasing the incidence of stromal keratitis and iridocyclitis.

    * Stromal keratitis - Prior to treatment of stromal disease, the
status of the epithelium needs to be evaluated. If stromal disease is
accompanied with a concomitant epithelial defect, it is treated
similar to epithelial keratitis with a topical antiviral and a
cycloplegic agent until the epithelium has healed. Both necrotizing
and nonnecrotizing stromal disease without associated epithelial
disease or after resolution of the epithelial defect are treated with
the following:

          o Topical corticosteroids - The strategy for topical
corticosteroid therapy is frequent initial administration (q1-4h)
followed by slowly tapering the dose to the lowest effective amount.

          o Topical or oral antivirals are recommended to prevent or
limit epithelial disease during the course of treatment with
corticosteroids. Many recommendations are available on the frequency
of administration of antivirals for prophylaxis. A most commonly used
regimen includes administering the drops as often as the recommended
therapeutic dose needed to treat epithelial disease. Another regimen
includes initiating and tapering the antiviral in the same dosage as
the corticosteroid until corticosteroid therapy tapers down to once a
day, at which time the topical antiviral is discontinued. The Herpetic
Eye Disease Study group recommended using trifluridine, 4 times a day
for 3 weeks and 2 times a day thereafter.

          o Associated elevated intraocular pressure should be treated
with timolol and systemic acetazolamide, as necessary.

          o Topical cyclosporin A 2% drops in an uncontrolled study
showed efficacy in the treatment of stromal disease without the use of
corticosteroids. A role may exist for this medication in those
patients unable to use corticosteroids.

          o Indolent stromal ulceration is managed with antiviral and
corticosteroid therapy along with a soft contact lens to prevent
corneal drying. When melting of the cornea occurs, care must be taken
not to stop corticosteroid therapy abruptly, as doing so may lead to
rebound inflammation and increase the melting process, thereby
resulting in perforation. The anticollagenolytic activity of
tetracycline may help retard corneal melting when applied as a topical
ointment. Consider the possibility of medication-induced toxicity or
an anesthetic cornea when faced with chronic, nonhealing, epithelial
defects associated with stromal inflammation. Occasionally, a lateral
tarsorrhaphy may be required to treat a nonhealing epithelial defect.


Siento el inglés...

Saludos.

El 12/04/07, Eduardo Satué <e.satue.000 en recol.es> escribió:
> Entiendo que hay razones para todo, pero lo adecuado es que el clínico
> explique sus razones si surgen discrepancias. Por cierto, las
> contraindicaciones se cumplen siempre, otra cosa es que el beneficio/riesgo
> sea indicado. Lo que no se cumple siempre son las RAM
>
> Eduardo Satue
>
>
>
>
> -----Mensaje original-----
> De: af
> En nombre de M.MARES
> Enviado el: jueves, 12 de abril de 2007 11:45
> Para: AF - Uninet
> Asunto: Re: [AF] zovirax+cortisona
>
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-- 
Ramón Díaz-Alersi