Abstract
Herpes Simplex Virus (HSV) has worldwide prevalence. The primary objective of this systematic review was to compare penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) regarding the efficacy and complications of the treatment of corneal scarring caused by herpes simplex keratitis. Out of the 469 articles identified during the combined search of the literature based on the PubMed and Cochrane libraries, 10 retrospective and 2 prospective studies published from January 2010 to December 2019 were included. The study outcomes indicated that both surgical approaches resulted in a comparable improvement of visual acuity (VA). However, DALK demonstrated fewer complications in the majority of studies. Higher graft survival rates were associated with higher acyclovir (ACV) doses (above 800 mg/day), topical steroid and antibiotic drops. In conclusion, in terms of postoperative VA, both PK and DALK demonstrate comparable efficacy. However, DALK, which is applied in less severe HSK cases, is associated with fewer complications and better graft survival rates. High dosages of ACV, topical steroids and antibiotics contribute significantly to improved postoperative outcomes.
Highlights
Herpes Simplex Virus (HSV) which belongs to the herpesvirus family is usually asymptomatic, it may affect a great variety of organs (1–2)
Original articles and case series with 5 or more subjects were included whose main or secondary goal was to demonstrate outcomes regarding deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK) or both interventions in populations suffering from corneal scarring as a result of Herpes Simplex Keratitis (HSK)
The present systematic review compared PK and DALK techniques in patients suffering from HSK-related corneal scarring
Summary
Herpes Simplex Virus (HSV) which belongs to the herpesvirus family is usually asymptomatic, it may affect a great variety of organs (1–2). The virus gains the ability to travel up the axon of the corresponding nerve and colonize the corresponding ganglion, where it lies in a latent state (4). The virus replicates and travels down the axon of the sensory nerve to its target tissue, causing recurrent infection and stimulating an inflammatory response. The spectrum of ocular disease caused by HSV is wide and depends on the target tissue that is infected. Both the anterior and posterior segments of the eye can be involved; among them, herpetic blepharitis, conjunctivitis, keratitis, as well as herpetic uveitis (iridocyclitis or trabeculitis) are some possible manifestations. In the most severe and rare cases, necrotizing herpetic retinopathy may occur with devastating outcomes to the visual capacity
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