Treatment of herpes simplex virus stromal keratitis unresponsive to topical prednisolone 1% with topical cyclosporine 0.05%

PURPOSE: To assess the efficacy of topical cyclosporine 0.05% (Restasis) in patients with herpes simplex virus nonnecrotizing stromal keratitis unresponsive to topical prednisolone. DESIGN: Prospective case series. METHODS: Patients with herpes simplex virus stromal keratitis (n = 12) that was unresponsive to topical prednisolone acetate 1% for at least four weeks were evaluated at a single site. Eyes were treated with topical cyclosporine twice a day and begun on a rapid prednisolone taper. Visual acuity, slit-lamp appearance, intraocular pressure, and corneal sensitivity were evaluated every two weeks for at least three months. RESULTS: Stromal keratitis resolved with cyclosporine in 10 of 12 patients after one month. The mean lesion area decreased more with cyclosporine than with prednisolone (2.0 mm with cyclosporine compared with 0.25 mm with prednisolone). After stopping cyclosporine therapy, four patients had recurrence of stromal keratitis. CONCLUSION: This series suggests that herpes simplex virus stromal keratitis can be treated effectively with topical cyclosporine, particularly in cases that are not responsive to topical prednisolone.