Treatment of Leucoma after Disciform Keratitis

Introduction to Treatment

The American Academy of Ophthalmology recommends using the minimum amount of corticosteroids necessary to control inflammation, with the goal of minimizing corneal scarring and optimizing visual recovery 1

The American Academy of Ophthalmology suggests maintaining antiviral therapy throughout the period of corticosteroid use to prevent viral reactivation, with a strength of evidence based on clinical guidelines 1
Prednisolone acetate 1% or phosphate 1% is recommended, 4 times a day, with dosage adjustments based on clinical response 1, 2
Corticosteroids should be avoided if Nocardia or fungal infection is suspected, due to the risk of worsening the infection 1, 2
For patients with herpes simplex virus (HSV) or varicella-zoster virus (VZV) infections, aciclovir topical 5 times a day or aciclovir oral 400mg 5 times a day is suggested, in combination with corticosteroids, to effectively manage disciform keratitis 1

Regular monitoring of intraocular pressure is necessary to prevent complications such as glaucoma, with a strength of evidence based on clinical guidelines 1
Patients should be informed about the risks of long-term corticosteroid therapy, including cataracts and glaucoma, to ensure informed decision-making 1
Patients should be evaluated for clinical response every 24-48 hours initially, with signs of improvement including reduction of stromal edema, decrease in keratic precipitates, improvement in visual acuity, and reduction of anterior chamber inflammation 1
If no improvement is seen within 48 hours, consideration should be given to increasing the frequency of corticosteroids, reevaluating the etiologic diagnosis, or performing corneal culture or biopsy if non-viral infection is suspected 1

Chronic use of topical immunotherapy increases the risk of infectious crystalline keratopathy, highlighting the need for careful management and monitoring 1, 2
The American Academy of Ophthalmology recommends a gradual reduction of corticosteroids based on clinical response, with consideration of prophylactic antiviral therapy in cases of recurrence, to minimize the risk of complications and promote optimal outcomes 1
Frequent visits during the acute phase and long-term monitoring are necessary to detect recurrences, and in cases of recurrence, consideration should be given to prophylactic antiviral therapy 2
The treatment of disciform keratitis requires careful regulation of corticosteroid dosage, optimal timing of application, and concurrent antiviral medication, as well as close monitoring, to achieve successful outcomes 2