• What antivirals are best after a corneal transplant due to herpes?


    Question:

    Should you be prescribed such things as Viroptic eye drops or Vira-A ointment (first given to treat herpes) after you have a cornea transplant due to herpes? Or is the pill valcyclovir the only option after surgery?


    Answer:

    Patients who have a history of herpetic eye infections have a higher risk of recurrence after having a corneal transplant. These patients should be on prophylactic (preventative) anti-virals while they recover from surgery. The best choices are topical ganciclovir (Zirgan) or oral acyclovir or valacyclovir (Valtrex).

    I prefer Valtrex because it is well tolerated with few side effects or risk for toxicity. All topical anti-virals cause some degree of damage to the surface of the cornea. Trifluridine (Viroptic) and vidarabine (Vira-A) are the worst offenders and have been largely replaced by Zirgan. However, most ophthalmologists prefer Valtrex because even Zirgan causes some corneal damage.


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