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Penetrating keratoplasty outcomes for deep corneal scarring resulting from herpes simplex virus keratitis

Poster Details

First Author: R.Couceiro PORTUGAL

Co Author(s):    A. Barata   A. Quintas   P. Guerra   J. Franco   W. Rodrigues   M. Monteiro-Grillo

Abstract Details

Purpose:

Patients undergoing penetrating keratoplasty (PKP) for corneal opacification related to herpes simplex virus (HSV) keratitis have a greater risk of complications (recurrence, graft rejection, graft failure) and poor visual outcome. We aimed to evaluate the surgical and functional results of PKP and to describe the management of complications in patients with deep corneal scarring resulting from HSV keratitis.

Setting:

Cornea Department - Hospital de Santa Maria, Lisbon.

Methods:

We retrospectively reviewed all patients who underwent unilateral PKP for long-standing corneal scarring due to herpes simplex virus keratitis, during a 2 year period. Patients submitted to PKP for perforating HSV keratitis and patients with a follow-up of less than 1 year were not included. We accessed patient’s information on preoperative period - age, best corrected visual acuity (BCVA), corneal neovascularization; type of surgery performed (PKP or PKP and simultaneous cataract surgery), complications and post-operative BCVA. All patients were under prolonged prophylatic antiviral oral therapy after PKP.

Results:

11 patients included (5 female, 6 male), with a mean age of 61 years. Mean follow-up was 23 months. Preoperative BCVA ranged from light perception to 20/100. 7 patients (64%) evidenced corneal vascularization. 2 patients underwent simultaneous cataract surgery. BCVA at last follow-up visit revealed an improvement of at least 1 line in ETDRS chart in 10 patients (91%), 6 of which had an improvement of 8 or more lines (73%). One patient experienced recurrent HSV graft infection. Three patients suffered graft rejection, all managed with topical steroids (two patients with preoperative corneal vascularization).

Conclusions:

Corneal scarring as a result of HSV keratitis can cause major visual impairment. Although commonly associated with a higher risk of complications, PKP can still achieve major improvements in visual acuity in such cases. Awareness of the risk factors for failure is important in order to predict and prepare for timely intervention if necessary.

Financial Disclosure:

NONE

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