title: [Herpes simplex keratitis. On the long-term prognosis of first transplants after penetrating keratoplasty].
abstract: Eighty-six consecutive first grafts performed between 1980 and 1990 (86 patients) for herpes simplex keratitis (HSK) were studied retrospectively (mean follow-up 4.1 years). Indications for penetrating keratoplasty (PKP) included: persistent inflammation, descemetocele or perforation (21/86); stromal opacities with vascularization (43/86), and avascular stromal opacities (22/86). The overall survival rate of clear transplants was 80% after 2 and 68% after 11 years. Corneal inflammation at the time of surgery was found to be a prognostic factor, but not corneal vascularization: The 2-year survival rates for clear grafts were 95% for avascular and 83% for vascularized stromal opacities in clinically inactive eyes, as against 58% for clinically active corneas at the time of surgery. HSV-specific structural proteins were immunohistochemically detectable most often in keratectomy specimens from patients with corneal inflammation before the operation (91%). In the group of clinically inactive stromal opacities, HSV antigens were detectable significantly (P < 0.001, chi-square test) more often in keratectomy specimens from patients with avascular opacities than in those with vascularized opacities. This may explain why corneal vascularization is not a significant risk factor for HSV recurrences. The different frequency of HSV-specific proteins in avascular and vascularized corneas merits attention in the intra- and postoperative management of patients with HSK undergoing corneal transplantation.
authors.affiliation: Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
authors.forename: L M
authors.initials: LM
authors.lastname: Holbach
authors.forename: J
authors.initials: J
authors.lastname: Bayer
authors.forename: B
authors.initials: B
authors.lastname: Seitz
authors.forename: C
authors.initials: C
authors.lastname: Rummelt
authors.forename: G O
authors.initials: GO
authors.lastname: Naumann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016849:Keratitis, Herpetic / Q000209:etiology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors
vernacular_title: Herpes-simplex Keratitis. Zur Langzeitprognose von Ersttransplantaten nach perforierender Keratoplastik.