Abstract
To determine the outcomes of penetrating keratoplasty (PK) for treatment of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether the corneal scar type affects treatment outcome. A retrospective analysis of patients who underwent PK for HSV-related corneal scarring between January 2008 and July 2011 was performed. The patients were categorized into two groups. Group 1 consisted of patients with a quiescent herpetic corneal scar and group 2 consisted of patients who developed a corneal descemetocele or perforation secondary to persistent epithelial defects with no active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, graft failure, visual acuity, and graft survival rate. There were 42 patients in group 1 and 13 in group 2. Preoperative BCVA varied from hand movements to 0.7 logMAR. Postoperatively, 34 patients (61.8%) achieved visual acuity of 0.6 logMAR or more. Recurrence of HSV keratitis was noted in 12 (28.57%) eyes in group 1 and 4 (30.76%) eyes in group 2 (p=0.40). Graft rejection occurred in 4 eyes (9.52%) in group 1 and in 3 (23.07%) eyes in group 2 (p=0.58). The 1-, 2-, and 3-year graft survival rates were 91.9%, 76.0%, and 65.1% in group 1, and 89.5%, 76.0%, and 63.6% in group 2 (p=0.91), respectively. Although there were different recurrence and graft rejection rates for two groups, the graft survival rates at 3 years were similar. According to our results, without inflammation, corneal herpetic scarring with a descemetocele or perforation achieved similar graft survival rates with quiescent herpetic corneal scars.
Highlights
Herpes simplex keratitis (HSK) is a major cause of vision morbidity worldwide[1,2]
Penetrating keratoplasty (PK) is a conventional surgical procedure for treatment of HSK-induced corneal scarring[3,4,5,6]; the success of corneal transplantation due to herpetic corneal scarring is lower as compared to other common indications, such as keratoconus, corneal dystrophy, and bullous keratopathy[7]
HSK can recur in corneal allografts and is sometimes difficult to distinguish from graft rejection
Summary
Despite improvements in diagnosis and medical treatment, recurrence of HSK is common and leads to severe corneal scarring and sometimes descemetocele formation or perforation. Corneal transplantation is needed to recover corneal clarity and rehabilitation of visual acuity. Penetrating keratoplasty (PK) is a conventional surgical procedure for treatment of HSK-induced corneal scarring[3,4,5,6]; the success of corneal transplantation due to herpetic corneal scarring is lower as compared to other common indications, such as keratoconus, corneal dystrophy, and bullous keratopathy[7]. The reduced survival rate of corneal grafts in patients undergoing PK for herpetic eye disease is mainly attributed to the recurrence of herpetic infection and immune reaction. The postope rative course in these cases can be complicated by high rates of re currence, graft rejection, and graft failure[8,9]
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