Oral Acyclovir After Penetrating Keratoplasty for Herpes Simplex Keratitis

Abstract

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.

Specific antibody production in herpes keratitis: intraocular inflammation and corneal neovascularisation as predicting factors

“…Generally, this test might be useful in patients with the consequence of prolonged anti-viral therapy who requires a clear diagnosis before deciding on a specific treatment, for instance, corneal allograft recipients [27].…”

“…Because individuals with previous stromal keratitis are at high risk to develop more severe disease, prophylaxis is a substantial means to reduce the personal, social, and financial burdens [15]. A randomized, placebo-controlled clinical trial demonstrated a significantly reduced recurrence rate following twice daily oral acyclovir during a 1-year observation period [11]; long-term acyclovir therapy is known to significantly improve graft outcomes [27] and prevent viral recurrences [29]. Early diagnosis of HSV keratitis is also important in corneal allograft recipients, and HSV keratitis has been described in patients with no history of herpes disease [4,23].…”

Antiviral treatment following penetrating keratoplasty for herpetic keratitis

“…The potential benefits include higher plasma levels of the drug and reduced frequency of administration, although in practice the actual dosage and frequency of antiviral medication required remains uncertain. Treatment with acyclovir 400 mg twice daily for at least 1 year postoperatively has been previously recommended 6,8,13 but longer treatment may be indicated. Conversely, Jansen et al 14 have reported follow-up data for patients given only 6 months postoperative oral acyclovir following PK for HSV keratitis.…”

Hornhaut-Transplantation in Hochrisikosituationen

“…Bei Patienten mit erhöhtem Risiko für ein erneutes Auftreten einer Herpes-simplex-Keratitis ist eine Dosierung von 800-1000 mg täglich für 6-12 Monate erforderlich [35,36]. In Fällen mit hohem Risiko für eine immunvermittelte Abstoßung und wiederkehrende Herpes-Keratitis ist zusätzlich Mycophenolat-Mofetil (MMF) 2 × 1 g täglich für 6-12 Monate zu verabreichen [37].…”