Management Of Corneal Transplantation For Herpetic Keratitis

This work aims to take stock of the interest of pre operative preparation and regular post operative follow-up of patients with herpetic keratitis in the prevention of the risk of rejection of the graft.

The study was conducted at the ophthalmology department of the Mohammed VI University Hospital in Marrakesh. A cohort of 20 patients with herpetic keratitis benefited of a penetrating keratoplasty was retrospectively reviewed over a three-year period (September 2020-September 2023). 

The data of the study were collated from the medical records of the patients and collected on an exploitation sheet including age, sex, indication for transplantation, type of procedure, trephine size, pre-operative risk factors. Antiviral prophylaxis with valaciclovir was administered 48 hours before surgery and maintained for at least a year. All patients received local corticosteroid therapy to control corneal neovascularization. A simple penetrating keratoplasty was effected in 18 cases and combined with cataract surgery for the rest. We used separate points to suture our grafts; the average diameter was 7.5 mm.

 Analysis of the data revealed that post surgery visual acuity has been improved to 3/10 in 50% of cases. For the main cases (60%), the corneal graft was clear. We reported a herpetic recurrence (2 cases), graft rejection (3cases) and delayed corneal epithelial healing (2 cases) which was treated by an amniotic membrane graft in one of the two patients. The corneal neovascularization was noticed in 2 cases and managed by improving topical corticosteroid.

In conclusion, corneal transplantation in herpetic keratitis is related to a high risk of recurrence and rejection. The corneal neovascularization is a main risk factor for graft rejection, requiring a prior corticosteroid therapy. Valaciclovir is also useful to preventing the herpetic recurrence.