Prognosis and management of corneal transplantation for herpetic keratitis
L. M. Cobo, D. J. Coster, N. S. Rice and B. R. Jones
One hundred thirty-two penetrating keratoplasties (91 patients) for
herpetic keratoplasty were reviewed retrospectively. The overall survival
rate of clear keratoplasties to two years was 64% and to five years was
62%. The significant prognostic factors were preoperative ocular
inflammatory status and degree of corneal vascularization. The two-year
survival rate of a clear keratoplasty was 69% where eyes were inflamed at
the time of surgery, compared with 44% in actively inflamed eyes. Allograft
rejection, the major cause of a clouded herpetic keratoplasty, increased in
frequency with increasing corneal vascularization. Antiviral cover was not
used with routine postoperative steroids or with steroid intensive therapy
for rejection. Epithelial herpetic recurrences occurred in 32% of eyes
undergoing allograft rejection within four months of initiation of
treatment for rejection. This is compared with otherwise uncomplicated
keratoplasties where the epithelial recurrence rate was 6% at four months,
on high-dose postoperative corticosteroid therapy without antiviral cover.
