The outcome of corneal grafting in patients with stromal keratitis of herpetic and non-herpetic origin.
OBJECTIVE
To evaluate the outcome of corneal grafting in patients with stromal keratitis of herpetic (HSK) and non-herpetic origin, using predefined diagnostic criteria and standardised postoperative therapeutic strategies.


METHODS
384 adult immunocompetent recipients of a corneal graft for herpetic (n = 186) or non-herpetic (n = 198) keratitis were followed up prospectively for up to 5 years.


RESULTS
The herpetic group displayed significantly more corneal vascularisation (p = 0.013), more epithelial defects (p = 0.049), lower corneal sensitivity (p <0.001), more graft rejection episodes (p = 0.002), and required larger grafts (p<0.001). However, the postoperative course of visual acuity, endothelial cell numerical density, and rate of graft failures were similar in both groups. After 5 years, cumulative probability of graft survival in HSK patients (40.85%) was similar to that observed in individuals with non-herpetic keratitis (50.15%; log rank = 0.874; relative risk: 1.04).


CONCLUSIONS
Despite a markedly higher preoperative risk profile in herpetic eyes, the functional outcomes of grafts in individuals with keratitis of herpetic or non-herpetic origin were similar. Probably the most important contribution is a consequent close follow up and a therapeutic strategy including systemic prophylaxis of viral recurrence and of graft rejection by well adopted local steroid therapy.
Halberstadt
M
M
Department of Ophthalmolgy, University of Bern, Inselspital, CH-3010 Bern, Switzerland.
Machens
M
M
Gahlenbek
K-A
KA
Böhnke
M
M
Garweg
J G
JG
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016039:Corneal Transplantation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007634:Keratitis / Q000601:surgery; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity
D000998:Antiviral Agents