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Fabiana P. Tambasco, MD; Elisabeth J. Cohen, MD; Lien H. Nguyen, MD; Christopher J. Rapuano, MD; Peter R. Laibson, MD

Arch Ophthalmol. 1999;117:445-449.

Objective  To determine the efficacy of systemic acyclovir in decreasing complications and improving the outcome of penetrating keratoplasty for herpes simplex virus (HSV) keratitis.

Methods  Retrospective study of 53 primary penetrating keratoplasties for HSV keratitis at an eye hospital from January 1, 1989, through December 31, 1996. Medical records were analyzed for history of HSV keratitis, preoperative neovascularization, and disease activity. Postoperative use of acyclovir, recurrence of HSV keratitis, rejection, uveitis or edema, and graft failure were evaluated.

Results  Twenty-four patients (mean±SD follow-up, 44.7±32.6 months) received no acyclovir and were compared with 20 patients, (mean±SD follow-up, 28.8±16.7 months), who received 400 mg acyclovir twice a day for at least 1 year. No patient in the acyclovir group had a recurrence of dendritic keratitis in the first year compared with 5 (21%) of the patients who did not receive acyclovir (P=.03). No patient had graft failure in the acyclovir group compared with 4 (17%) in the group without acyclovir after 1 year of follow-up (P=.06).

Conclusion  Postoperative systemic acyclovir therapy after penetrating keratoplasty for HSV keratitis is associated with a reduced rate of recurrent HSV dendritic keratitis and possible graft failure at 1 year of follow-up.

From the Cornea Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pa.

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