Evaluation of therapeutic interventions for vaccinia virus keratitis

Sharon Altmann, Curtis R. Brandt, Christopher J Murphy, Ravi Patnaikuni, Teresa Takla, Megan Toomey, Brittany Nesbit, Kimberly McIntyre, Jill Covert, Richard Dubielzig, Gary Leatherberry, Elizabeth Adkins, Shantha Kodihalli

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background. Vaccinia virus keratitis (VACVK) is a complication of smallpox vaccination that can result in blindness. There are no Food and Drug Administration-approved treatments for VACVK, and vaccinia immunoglobulin (VIG) is contraindicated in isolated VACVK. We used a rabbit model of infection to compare several therapeutic options for VACVK. Methods. Rabbit eyes were infected with 105 plaque-forming units of the Dryvax strain of vaccinia virus and scored daily for 28 days using a modified MacDonald-Shadduck scoring system. Animals were treated for 10 days after the onset of keratitis with albumin, VIG, prednisolone acetate, trifluridine, or combinations thereof. Ocular viral titers and vaccinia-specific antibody titers were determined by plaque assay and enzyme-linked immunosorbent assay, respectively. Results. Treatment with intravenous VIG neither exacerbated nor ameliorated VACVK. Topical prednisolone acetate interfered with viral clearance, and ocular disease rebounded in prednisolone-treated groups. The most effective treatment was topical trifluridine alone. Conclusions. We conclude that (1) VIG did not negatively affect the treatment of isolated keratitis, (2) topical corticosteroids should not be used for treating VACVK, and (3) treatment with topical trifluridine, with or without intravenous VIG, is the preferred therapeutic regimen for treating VACVK.

Original languageEnglish (US)
Pages (from-to)683-690
Number of pages8
JournalJournal of Infectious Diseases
Issue number5
StatePublished - Mar 1 2011

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy


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