What is the role of keratoplasty in the treatment of herpes simplex virus (HSV) keratitis?

Updated: Jan 18, 2019
  • Author: Jim C Wang (王崇安), MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Irregular astigmatism resulting from chronic stromal keratitis may be correctable with rigid, gas-permeable contact lenses. Patients with visually significant corneal opacities or corneal perforations may require keratoplasty for visual rehabilitation. [27]

Although an uncommon occurrence, progressive necrotizing stromal keratitis and impending corneal perforation may be better managed with tissue glue and bandage contact lens before considering keratoplasty.

If possible, a small descemetocele or perforation in an inflamed eye may initially be managed with tissue adhesive, a bandage contact lens, and/or amniotic membrane transplantation. [28] Corneal transplantation should ideally be deferred until the eye is less inflamed.

The prognosis for a successful graft approaches 80% in eyes without inflammation prior to surgery. Prophylactic oral antiviral therapy following penetrating keratoplasty reduces recurrent ocular HSV disease and graft rejection episodes and improves graft survival. Most surgeons use a systemic antiviral agent (eg, acyclovir 400 mg bid) for at least 6-12 months after penetrating keratoplasty. [29, 30, 31] Interestingly, because recurrent HSV disease is the result of reactivation of latent virus in the nerve ganglion, the rate of disease recurrence is not altered after penetrating keratoplasty. Anterior lamellar keratoplasty may be considered in lieu of penetrating keratoplasty in patients with healthy corneal endothelium.

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