Ocular herpes

[Anonymous]

Have you seen any instances of ocular herpes in a T-VEC treated patient?

[Alayna Wilson]

I have not; though admittedly our experience with T-Vec is fairly limited at this time.

[Anonymous]

I have not seen any ocular herpes and we have been doing T-VEC routinely for about two years. I have had two patients develop occasional canker sores during therapy, but both of them had a history of this before starting T-VEC.

[Samantha Guild]

We too have had limited experience with T-VEC but of those patients, the only AE’s we observed were more consistent with flu like symptoms which were treated with benadryl, acetaminophen & sometimes prednisone, but typically for the first 24 hours after the injection. Regarding ocular herpes, my experiences with this is a compication typically associated with an outbreak of shingles along the ophthalmic or maxiallary dermatome which has impacted the eye, but none of these were related to T-Vec. It is possible to aquire a localized herpetic infection from other sources of contact.

[Alayna Wilson]

Curious to hear how others would handle:

Would your practice consider TVEC for a patient with a HISTORY OF recurrent herpetic infections (including ocular) that required daily suppression?

[Anonymous]

Hi Krista-

That is a very interesting question. I think this would be a difficult situation and I would want to reserve this treatment for a setting where other therapies have failed. I would not absolutely rule it out.

[Alayna Wilson]

Thanks Lisa. The patient has lesions that are ideal to inject…but the ocular herpes history makes me nervous. Other options are being explored.

[Anonymous]

Krista, my hesitation would be the need for chronic suppression with antivirals as this could potentially decrease the efficacy of T-VEC. However, if other options are limited or exhausted, it would be reasonable to consider with close monitoring for recurrent ocular symptoms.

[Author]

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