Herpetic keratitis following penetrating keratoplasty: clinical and microbiological features

Abstract

Purpose : The present study aims to describe clinical outcomes after infectious keratitis following penetrating keratoplasty (PKP)

Methods : Retrospective consecutive clinical case series study carried out from 2001 to 2018. Clinical records were reviewed in which subjects with herpetic keratitis with previous PKP were identified. Diagnosis was done following clinical characteristics. Analyzed variables were previous ocular surgeries and medications and ocular surface disease were recorded. Treatment characteristics, indications for surgery and clinical outcomes were also noted. Descriptive statistics, means, and SD were used for continuous variables; percentages were used to describe categorical variables. P, 0.05 was regarded as evidence of significance. All analyses were done with STATA v.10 software.

Results : A total of 22 cases were recorded. Mean age was 43.04 years, 14 patients (63.63%) were male. Mean time of herpetic keratitis after PKP was 35.59 months (2.96 years). Of the 22 cases 19 (86.36%) had just one PKP, 3 patients (13.63%) had 2 or more PKP’s. 15 patients (68.18%) had history of herpetic keratitis before the PKP. The main indication for PKP among patients with history of herpetic keratitis were: stromal keratitis in 14 patients (93.33%) and just one case of endothelial keratitis (6.66%). Of the 15 patients who presented herpetic keratitis previous to the PKP only 3 (20%) were on antiviral suppression therapy. Of the 22 patients who presented herpetic keratitis, 17 (77.27%) presented epithelial form and 5 patients (22.72%) presented herpetic keratouveitis .Of the 22 patients, 13 (59.09%) had clear grafts, the remaining 9 grafts were already in failure (40%). 8 (61.53%) remained clear after the event, 5 (38.46%) resulted in marked inflammation, leading to graft failure. Before the infectious event 18 patients (81%) were active steroid users, 4 patients (17.39%) were on prostaglandin analogues and at the time of the event all the patients were treated with: acyclovir 800mg 5 times daily and lubricant drops.

Conclusions : Herpetic infectious keratitis following PKP is an important cause of graft failure. Patients with PKP require close monitoring to identify risk factors for developing infectious keratitis and posterior graft failure. Patients whose transplant was for a herpetic cause, require close monitoring and prompt identification of any visual or graft changes to start appropriate treatment.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.