Prevention of Recurrence in Postherpetic Corneal Transplantation

Abstract

Abstract: : Purpose: Corneal graft failure may be a result of a recurrence of HSV infection. Antiherpetic therapy following penetrating keratoplasty for HSV keratitis was reported to decrease the recurrence of HSV infection in the graft. Methods: The study was performed on two groups of patients: 1/ retrospective study on 71 patients with herpetic keratitis and corneal opacities who underwent penetrating keratoplasty during the period of three years (1996-1999).2/ prospective study on 10 consecutive patients with keratoplasty for HSV keratitis for the period of one year (1999-2000). All patients from both groups were without evidence of active infection at the time of first keratoplasty. Results: Recurrent keratitis was observed in 35 patients (50%) from the first group. Specific epithelial defect with precipitates formation was the main symptom. Oral treatment with acyclovir led to improvement in 20 cases. HSV recurrence was difficult to distinguish from graft rejection episodes. In two patients progressive stromal disease led to perforation of the graft. In this group of patients rekeratoplasty was performed on 15 cases (21,2% of all patients), because of dense opacities. Patients from second group received prophylactic oral acyclovir after keratoplasty for a period of 6 months. No recurrent herpetic keratitis was diagnosed for a period of 18 months post surgery. Follow up of patients with prophylactic oral antiviral therapy is in progress. Conclusions: Recent data suggest that the human cornea may be a site of latency and a potential source of recurring HSV. Early diagnosis of recurrent HSV infection on graft and antiherpetic treatment did not prevent rekeratoplasty in half of patients in our study. Preventive postoperative therapy of patients with corneal opacities due to HSV keratitis is recommended.

Keywords: transplantation • cornea: clinical science • herpes simplex virus