Data_Sheet_1_Antiviral Therapy for Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV)-Induced Anterior Uveitis: A Systematic Review and Meta-Analysis.DOC

Topic: Herpes simplex virus (HSV) and varicella zoster virus (VZV) are the most common ocular pathogens associated with infectious anterior uveitis. Currently, there are a number of antiviral agents administered to treat viral anterior uveitis (VAU). However, there is no consensus or guidelines about the most appropriate approach leading for the best treatment outcomes with fewer ocular complications.
Clinical Relevance: To perform a systematic review and meta-analysis of the efficacy of different antiviral therapies in the management of anterior uveitis secondary to HSV and VZV.
Methods: We searched PubMed, Web of Science, CINAHL, OVID, and Embase up to January 2020. Randomized trials, non-randomized intervention studies, controlled before and after studies and observational studies assessing the effect of oral and or topical treatments for VAU were considered. Data extraction and analysis with evaluation of the risk of bias in the included trials were performed.
Results: Oral acyclovir demonstrated a statistically significant good treatment outcome in the management of VZV anterior uveitis (vs. placebo) (OR 0.26, 95% CI 0.11–0.59), but did not have similar effect in HSV anterior uveitis (OR 0.47, 95% CI 0.15–1.50). In the treatment of VZV anterior uveitis, there was significant superiority of oral acyclovir−7 day course—over topical acyclovir (OR 4.17, 95% CI 1.28–13.52). Whereas, there was no significant superiority of one of the following treatment regimens over the others: topical acyclovir over topical corticosteroids (OR 1.86, 95% CI 0.67–5.17), and oral acyclovir−7 day course—over oral acyclovir−14 day course—(OR 0.21, 95% CI 0.01–4.50) or oral valaciclovir (OR 1.40, 95% CI 0.48–4.07).
Conclusion: Treatment of HSV and VZV anterior uveitis is currently based on individual experiences and limited literature, largely due to weak clinical trial evidence in this regard. Our results highlight the existence of a substantial gap in our evidence base. This finding might contribute to future research studies to ascertain the role of different antiviral therapies in the treatment of VAU.
Systematic Review Registration: PROSPERO registration number: CRD420202 00404.

主题：单纯疱疹病毒（Herpes simplex virus, HSV）与水痘-带状疱疹病毒（varicella zoster virus, VZV）是引发感染性前葡萄膜炎最常见的眼部病原体。目前临床已有多种抗病毒药物用于治疗病毒性前葡萄膜炎（viral anterior uveitis, VAU），但尚未形成统一共识或诊疗指南，以确定可获得最佳治疗效果且眼部并发症最少的最优治疗方案。
临床相关性：本研究旨在针对单纯疱疹病毒与水痘-带状疱疹病毒继发的前葡萄膜炎，系统评价不同抗病毒治疗方案的疗效并开展荟萃分析。
方法：我们检索了截至2020年1月的PubMed、Web of Science、CINAHL、OVID及Embase数据库。纳入评估口服及外用抗病毒药物治疗病毒性前葡萄膜炎疗效的随机对照试验、非随机干预研究、前后对照研究及观察性研究。随后完成数据提取与分析，并对纳入研究的偏倚风险进行评估。
结果：口服阿昔洛韦治疗水痘-带状疱疹病毒相关前葡萄膜炎时，与安慰剂相比可显著改善治疗结局（比值比OR=0.26，95%置信区间CI：0.11~0.59），但对单纯疱疹病毒相关前葡萄膜炎未表现出类似效果（OR=0.47，95%CI：0.15~1.50）。在水痘-带状疱疹病毒前葡萄膜炎的治疗中，7日疗程口服阿昔洛韦的疗效显著优于外用阿昔洛韦（OR=4.17，95%CI：1.28~13.52）。而以下治疗方案之间未体现出显著优势差异：外用阿昔洛韦相较于外用糖皮质激素（OR=1.86，95%CI：0.67~5.17）；7日疗程口服阿昔洛韦相较于14日疗程口服阿昔洛韦（OR=0.21，95%CI：0.01~4.50），或口服伐昔洛韦（OR=1.40，95%CI：0.48~4.07）。
结论：当前单纯疱疹病毒与水痘-带状疱疹病毒相关前葡萄膜炎的治疗仍基于临床医师个体经验与有限的文献证据，这在很大程度上源于该领域临床研究证据的薄弱。本研究结果凸显了当前证据体系存在的显著缺口，该发现可为未来明确不同抗病毒疗法在病毒性前葡萄膜炎治疗中作用的相关研究提供参考。
系统评价注册：PROSPERO注册编号：CRD42020200404。