Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty Treating Posterior Stroma–Implicated Herpetic Corneal Opacities

Ren, Yueping; Wang, Haiou; Zheng, Qinxiang; Tian, Peng-Fei; Ren, Weina; Jhanji, Vishal; Chen, Wei

doi:10.1097/ico.0000000000000742

Cited by 13 publications

(7 citation statements)

References 33 publications

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“…The conventional surgical procedure for treating HSK‐induced corneal ulcer is penetrating keratoplasty (PKP), but recent studies show an increase deep anterior lamellar keratoplasty (DALK) . A study by Wu et al compared full‐bed deep lamellar keratoplasty with penetrating keratoplasty in treating corneal scarring caused by Herpes Simplex Keratitis.…”

Section: Discussionmentioning

confidence: 99%

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Zheng

Huang

Zhang

et al. 2019

Xenotransplantation

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Background Corneal transplantation is a common surgical intervention for restoring vision loss due to corneal damages. However, for cultural reasons, there is a huge shortage of donor corneas in China. Acellular porcine corneal stromas (APCSs) can be used as corneal substitutes in lamellar keratoplasty for corneal ulcers. This study was conducted to analyze the results of APCS use for herpes simplex keratitis (HSK). Methods The study involved HSK patients who underwent keratoplasty with APCSs from February 2016 to October 2017 in the second affiliated hospital of Zhejiang University. Patient data were collected at 7 days, 1 month, 3 months, 6 months, and at the last follow‐up (7‐25 months) postoperative. The corneal transparency, neovascularization, visual acuity, and graft stability were observed. Results Thirteen patients with HSK including five patients with corneal perforation were included in this study, nine patients underwent deep anterior lamellar keratoplasty (DALK) and five perforation patients underwent double lamellar keratoplasty. There were nine men and four women with an average age of 62.5 ± 5.6 years old (ranging from 52 to 70 years old). The mean postoperative follow‐up duration was 15.1 ± 5.8 months (ranging from 7 to 25 months). At the last visit, visual acuity improved in nine patients (69.2%) compared with preoperative (P = 0.008).The grafts of seven individuals (53.8%) were completely transparent or slightly opaque; their corneal transparency score had improved significantly compared with before the surgery (P = 0.010). Various degrees of neovascularization were present in 11 of the 13 patients (84.6%), most neovascularization gradually stabilized. Graft dissolution occurred in three eyes (23.1%) during the observation period, two underwent regrafting, the other one became stable after treatment. Three patients underwent second allograft transplantation, two of which encountered APCS graft dissolution and one of the patients requested a human donor allograft transplantation due to transparency issues despite the absence of adverse issues. Conclusion Acellular porcine corneal stroma seems to be effective in the treatment of HSK and can be used in HSK with corneal perforation by using double lamellar keratoplasty in an emergency.

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Section: Discussionmentioning

confidence: 99%

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Zheng

Huang

Zhang

et al. 2019

Xenotransplantation

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“…Regarding DALK procedure (Table 2), a significant improvement in vision after the operations was described (21,(27)(28)(29). The rejection was lower than 5% in the studies of Ren et al (28) and Wang et al (29) in a 50.4-month and 31-month follow-up period, respectively, while no rejection was detected in a 31-month follow-up period according to…”

Section: Primary Outcomesmentioning

confidence: 92%

“…In the study of Lyall et al (27), increased IOP, bacterial keratitis and graft failure was found in 27.7% of the patients. Several complications including double anterior chamber, corneal endothelial decompensation and posterior stromal folds were described in 10.1%, 3.4% and 46.1% of the population, respectively, in Ren et al (28) records. No recurrence was noted in patients who had DALK procedure using ACT (32).…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Corneal Graft Success Rates in HSV Keratitis: A Systematic Review

Skarentzos

Chatzimichael

Panagiotopoulou

et al. 2020

Acta Med. (Hradec Kralove, Czech Repub.)

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Herpes Simplex Virus (HSV) has worldwide prevalence. The primary objective of this systematic review was to compare penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) regarding the efficacy and complications of the treatment of corneal scarring caused by herpes simplex keratitis. Out of the 469 articles identified during the combined search of the literature based on the PubMed and Cochrane libraries, 10 retrospective and 2 prospective studies published from January 2010 to December 2019 were included. The study outcomes indicated that both surgical approaches resulted in a comparable improvement of visual acuity (VA). However, DALK demonstrated fewer complications in the majority of studies. Higher graft survival rates were associated with higher acyclovir (ACV) doses (above 800 mg/day), topical steroid and antibiotic drops. In conclusion, in terms of postoperative VA, both PK and DALK demonstrate comparable efficacy. However, DALK, which is applied in less severe HSK cases, is associated with fewer complications and better graft survival rates. High dosages of ACV, topical steroids and antibiotics contribute significantly to improved postoperative outcomes.

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“…34 DALK which is less invasive surgery is maybe more suitable for refractive stromal keratitis. 35 Any ophthalmic surgery has been associated with recurrence of disease, including routine cataract surgery. 36 There have also been rare cases of spontaneous HK infection after cataract surgery 37 and it is postulated that the use of topical corticosteroids could promote recurrence.…”

Section: Recurrencementioning

confidence: 99%

Twenty years since the Herpetic Eye Disease Study: Lessons, developments and applications to clinical practice

Arshad

Petsoglou

Lee

et al. 2021

Clinical and Experimental Optometry

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Herpes Simplex Virus (HSV) is the most common virus that causes eye disease. Although around 60% of the world's population are seropositive for HSV antigens, fortunately, it is estimated that only 1% of seropositive individuals develop eye disease. The most common ocular manifestation of HSV is keratitis, while uveitis and retinal necrosis occur in a small number of cases. HSV keratitis is a debilitating disease, for several reasons: pain , photophobia, and vision loss in acute disease, latency of the virus which leads to infection reactivation from various triggers, scarring, and neovascularisation, leading to permanent vision loss with poor visual rehabilitation prospects. The Herpetic Eye Disease Study (HEDS) was a landmark series of randomised controlled trials in the 1990s that set the benchmark for evidence-based treatment guidelines for anterior eye herpetic disease. Since this time, there has been a change in the distribution of seroprevalence of herpes in the community, a simplified diagnostic classification, advances in treatment options, an emergence of new and a better understanding of risk factors, and discoveries in science that show promise for vaccine and novel future treatments. However, many of the principles of the HEDS study remain rightly entrenched in clinical practice. In this article, the HEDS study is revisited 20 years on through the lens of published literature, to determine current best practise and look towards the future.

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Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty Treating Posterior Stroma–Implicated Herpetic Corneal Opacities

Cited by 13 publications

References 33 publications

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Corneal Graft Success Rates in HSV Keratitis: A Systematic Review

Twenty years since the Herpetic Eye Disease Study: Lessons, developments and applications to clinical practice

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