A Cochrane review [Abstract] 1 included 106 studies with a total of 5 872 eyes. Idoxuridine, though uncertainly better in healing outcome than control because of few trials with 14-day follow up, allowed earlier corneal re-epithelialisation. Vidarabine resulted in a significantly better outcome than placebo in one trial (RR 1.96, 95% CI 1.10 to 3.49). Compared to idoxuridine, in combined direct and indirect analyses, vidarabine (RR 1.11, 95% CI 1.03 to 1.19), trifluridine (RR 1.31, 95% CI 1.20 to 1.42), acyclovir (RR 1.23, 95% CI 1.16 to 1.31), brivudine (RR 1.38, 95% CI 1.18 to 1.61), and ganciclovir (RR 1.40, 95% CI 1.25 to 1.57) were significantly more effective. Trifluridine (RR 1.12, 95% CI 1.04 to 1.21) and acyclovir (RR 1.11, 95% CI 1.05 to 1.19) appeared more effective than vidarabine. No significant differences were found in comparisons between acyclovir, trifluridine and brivudine. The comparison of ganciclovir to acyclovir was limited by heterogeneity and possible publication bias. The joint use of two topical antivirals (RR 1.00, 95% CI 0.89 to 1.12) and the use of oral acyclovir alone (RR 0.92, 95% CI 0.79 to 1.07) or combined with a topical antiviral (RR 1.08, 95% CI 0.99 to 1.17) appeared as effective as topical antiviral therapy. Compared to antiviral monotherapy, the combination of an antiviral with interferon (RR 1.03, 95% CI 0.99 to 1.07) or with débridement (RR 1.04, 95% CI 0.95 to 1.14) did not yield significantly better outcomes but may have accelerated healing. The corneal epithelial healing outcome was improved when antiviral therapy was added to débridement (RR 1.21, 95% CI 1.04 to 1.42).
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