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This abstract is assigned to session AOB Free Papers 2

Presentation type	Oral presentation
Title	Overcoming aciclovir resistance in herpetic keratitis

Purpose	To outline the medical management of herpetic keratitis and, when treatment fails, how aciclovir resistance is recognised and overcome — illustrated by a case.
Methods	A review of the literature combined with a clinical case: a 56-year-old woman with treatment-resistant dendritic keratitis.
Results	n this case, epithelial herpetic keratitis was resistant to multiple treatment regimens. Genotypic testing revealed a thymidine kinase mutation, and foscarnet was also ineffective. Resolution occurred only after switching to topical ganciclovir and discontinuing dexamethasone; however, a nummular stromal immune reaction subsequently developed once the dexamethasone was withdrawn.
Conclusion	Resistant cases are managed through a combination of higher dosing, alternative antivirals (foscarnet, ganciclovir, cidofovir, pritelivir), and reduced immunosuppression. Mixed viral populations and frequent cross-resistance can make treatment selection challenging.
Conflict of interest	No

Authors 1