Long-term Suppressive Valacyclovir Treatment for Herpes Zoster Ophthalmicus

带状疱疹性眼病研究（ZEDS）的目的是确定长期抑制性口服给药是否 用伐昔洛韦进行抗病毒治疗可减少带状疱疹眼（HZO）的并发症， 改善这种常见且可能危及视力和生命的疾病的临床结局。有 在美国，每年有1，000，000例带状疱疹（HZ）新发病例，其中10-20%为HZO。第一个目标是 一项双盲、安慰剂对照、多中心随机临床试验将检验以下假设： 口服伐昔洛韦1000 mg/d抑制性抗病毒治疗12个月， 与安慰剂相比，树枝状上皮角膜炎、基质角膜炎、内皮角膜炎或葡萄膜炎恶化， 12个月时作为主要终点，18个月时（包括治疗后6个月随访）作为 次要终点，发生过这些疾病表现之一的HZO患者 入组前一年。第二个目的是检验抑制性治疗12例 口服伐昔洛韦1000 mg/d可降低带状疱疹后神经痛（PHN）的严重程度和持续时间， 与安慰剂相比，在相似的HZO患者中，12个月和18个月时作为次要终点。 PHN是一种使人衰弱的慢性疼痛综合征，对生活质量产生负面影响，尤其是在老年患者中。 该研究将招募18岁及以上的免疫功能正常的患者，这些患者在不同的 次，与这些类型的活动性眼前节眼段疾病在过去的一年内。 符合条件的患者将以1：1的比例随机接受口服伐昔洛韦1000的长期抑制治疗 每日mg或安慰剂，持续12个月，加上常规眼科护理，每3个月随访一次，共18 月，以确定新发或恶化的树枝状上皮角膜炎，基质角膜炎， 内皮性角膜炎或葡萄膜炎和/或PHN的严重程度和持续时间 治疗停止后3个月。关于PHN的结果可能适用于其他地区的HZ 地点如果抑制性伐昔洛韦治疗被确定是有效的， HZO和HZ的疾病负担可能会减少患者，以及每年的社会成本，估计 在美国是10亿美元。

The objective of the Zoster Eye Disease Study (ZEDS) is to determine whether prolonged suppressive oral antiviral treatment with valacyclovir reduces complications of Herpes Zoster Ophthalmicus (HZO), thereby improving clinical outcomes in this common and potentially vision- and life-threatening disease. There are 1,000,000 new cases of Herpes Zoster (HZ) per year in the USA, with 10-20% being HZO. The first aim of this double-masked, placebo controlled multicenter randomized clinical trial will test the hypothesis that suppressive antiviral treatment for 12 months with oral valacyclovir 1000 mg daily reduces the rate of new or worsening dendriform epithelial keratitis, stromal keratitis, endothelial keratitis or uveitis compared to placebo, at 12 months as the primary endpoint, and at 18 months including 6 months of follow-up after treatment, as the secondary endpoint, in patients with HZO who have had an episode of one of these disease manifestations during the year prior to enrollment. The second aim is to test the hypothesis that suppressive treatment for 12 months with oral valacyclovir 1000 mg daily reduces the severity and duration of postherpetic neuralgia (PHN), compared to placebo, at 12 months and at 18 months as secondary endpoints, in similar patients with HZO. PHN is a debilitating chronic pain syndrome that negatively impacts quality of life, especially in elderly patients. The study will enroll immunocompetent patients age 18 years and older who have HZO diagnosed at variable times in the past, with these types of active anterior segment ocular segment disease within the past year. Eligible patients will be randomized in a 1:1 ratio to long-term suppressive treatment with oral valacyclovir 1000 mg daily or placebo for 12 months, plus usual ophthalmic care, and followed every 3 months for a total of 18 months, to determine outcomes of new or worsening dendriform epithelial keratitis, stromal keratitis, endothelial keratitis or uveitis and/or severity and duration of PHN during 12 months of treatment and for 6 months following treatment discontinuation. The results with regard to PHN may be applicable to HZ in other locations. If suppressive valacyclovir treatment is determined to be effective, the potentially devastating disease burden of HZO and HZ may be reduced for patients, as well as the annual costs to society, estimated in the USA to be one billion dollars.