To compare topical cyclosporine-A 2% eye drop (Cs-A) with prednisolone acetate 1% eye drop for treatment of herpetic stromal keratitis (HSK).

In this randomized clinical trial, 38 eyes of 33 patients with HSK were randomly assigned to receive either 2% Cs-A or 1% prednisolone acetate eye drops. All subjects received oral acyclovir 400 mg twice a day. Slit-lamp examination, Scheimpflug tomography corneal optical densitometry (Oculus Pentacam, USA), best-corrected visual acuity (BCVA), and intra-ocular pressure (IOP) were evaluated at the first visit, and 14 and 30 days after the treatment.

Within-group analysis revealed significant improvement of total cornea optical density after 30 days of treatment in both groups (30.3+/? 10.5 to 28.3 +/? 9.8, P < 0.001 for prednisolone group, and 30.5 +/? 8.8 to 28.8 +/? 8.3 P < 0.001 for Cs-A group, mean+/? SD). We were not able to disclose any significant difference between the two groups regarding the improvement of cornea optical density (P=0.66). BCVA logMAR significantly improved in both groups after 30 days of treatment (0.20 +/? 0.52, P = 0.002 in prednisolone group, and 0.24 +/? 0.31, P < 0.001 in Cs-A group, mean +/? SD). Analysis between groups did not show a significant difference of BCVA improvement (P = 0.45). We did not observe any severe side effect attributable to drugs.

Cs-A 2% and prednisolone acetate 1% topical eye drops are effective for treatment of HSK.