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Jeong, Lee, You, and Yoon: Recurrent Herpes Simplex Keratitis After Penetrating Keratoplasty
Original Article

J Korean Ophthalmol Soc 2009;50(5):657-663.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.5.657

Recurrent Herpes Simplex Keratitis After Penetrating Keratoplasty

In Young Jeong, MD1, Kwang Hoon Lee, MD1, In Cheon You, MD, PhD2, Kyung Chul Yoon, MD, PhD1

1Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea

2Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to Kyung Chul Yoon, MD Department of Ophthalmology, Chonnam National University Medical School & Hospital #8 Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 30 June 2008       Accepted 15 January 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical aspects and risk factors for recurrent herpes simplex keratitis (HSK) after penetrating keratoplasty (PKP).

Methods

Records from 78 eyes of 41 patients who underwent PKP for HSV keratitis with a mean follow-up duration of 31.83±21.35 months (24∼97 months) were reviewed. The clinical aspects of recurrent keratitis, rejection, and survival rate were evaluated. Previous operation history, preoperative inflammation and neovascularization, graft size, suture methods, and antiviral use were analyzed to elucidate the risk factor for recurrent HSK after PKP.

Results

HSK recurred in 47.4% of the patients at a mean time of 18.36±21.02 months after PKP. The mean duration of keratitis was 2.16±1.71 months and the mean frequency of recurrence was 1.41±0.69 times. Epithelial keratitis developed in 46.2% of the patients, and epithelial keratitis combined with stromal inflammation developed in 36.5%. Previous graft failure due to recurrent HSK and preoperative inflammation were significant risk factors for recurrent HSK after PKP (p=0.019, p=0.006). There were no statistically significant differences in graft rejection and survival rate between the two groups with and without recurrent HSK.

Conclusions

The majority of cases of recurrent HSK after PKP were epithelial keratitis or epithelial keratitis combined with stromal inflammation, and risk factors for the recurrence of HSK were previous graft failure due to recurrent HSK and preoperative inflammation.

Keywords: Herpes simplex keratitis, Penetrating keratoplasty, Recurrence

References

1. Ficker LA, Kirkness CM, Rice NS, Steele AD. The changing management and improved prognosis for corneal grafting in herpes simplex keratitis. Ophthalmology. 1989; 96:1587–96.
crossref
2. Xie L, Song Z, Zhao J, et al. Indications for penetrating keratoplastyaccommodative in north China. Cornea. 2007; 26:1070–3.
3. Ebstein RJ, Seedor JA, Dreizen NG, et al. Penetrating keratoplasty for herpes simplex keratitis and keratoconus. Ophthalmology. 1987; 94:935–44.
crossref
4. Cobo LM, Coster DJ, Rice NS, Jones BR. Prognosis and management of corneal transplantation for herpetic keratitis. Arch Ophthalmol. 1980; 98:1755–9.
crossref
5. Ficker LA, Kirkness CM, Rice NS, Steele AD. Longterm prognosis for corneal grafting in herpes simplex keratitis. Eye. 1988; 2:400–8.
crossref
6. Lomholt JA, Baggesen K, Ehlers N. Recurrence and rejection rates following corneal transplantation for herpes simplex keratitis. Acta Ophthalmol Scand. 1995; 73:29–32.
crossref
7. Sterk CC, Jager MJ, Swart-vd Berg M. Recurrent herpetic keratitis in penetrating keratoplasty. Doc Ophthalmol. 1995; 90:29–33.
crossref
8. Cohen EJ, Laibson PR, Arentsen JJ. Corneal transplantation for herpes simplex keratitis. Am J Ophthalmol. 1983; 95:645–50.
crossref
9. Jeong JS, Oh TH, Moon NJ. Clinical analysis of penetrating keratoplasty in herpes simplex keratitis. J Korean Ophthalmol Soc. 1998; 39:1111–8.
10. Rice NS, Jones BR. Problems of corneal grafting in herpetic keratitis, in Ciba Foundation Symposium on Corneal Graft Failure. Vol. 55. London: Associated Scientific Publishers;1973. p. 221–39.
11. Kim HI, Chung SK, Myong YW, et al. Clinical evaluation of recurrence after keratoplasty in herpes simplex keratitis. J Korean Ophthalmol Soc. 1992; 33:209–15.
12. Foster CS, Duncan J. Penetrating keratoplasty for herpes simplex keratitis. Am J Ophthalmol. 1981; 92:336–43.
crossref
13. Polack FM, Kaufman HE. Penetrating keratoplasty in herpetic keratitis. Am J Ophthalmol. 1972; 73:908–13.
crossref
14. Völker-Dieben HJ, Kok-van Alphen CC, D'Amaro J, de Lange P. The effect of prospective HLA-A and –B matching in 288 penetrating keratoplasties for herpes simplex keratitis. Acta Ophthalmol. 1984; 62:513–23.
15. Fine M, Cignetti FE. Penetrating keratoplasty in herpes simplex keratitis. Recurrence in grafts. Arch Ophthalmol. 1977; 95:613–6.
16. Rooij J, Rijneveld WJ, Remeijer L, et al. Effect of oral acyclovir after penetrating keratoplasty for herpetic keratitis. Ophthalmology. 2003; 110:1916–9.
crossref
17. Ghosh S, Jhanji V, Lamoureux E, et al. Acyclovir therapy in prevention of recurrent herpetic keratitis following penetrating keratoplasty. Am J Ophthalmol. 2008; 145:198–202.
crossref
18. Halberstadt M, Machens M, Gahlenbek KA, et al. The outcome of corneal grafting in patients with stromal keratitis of herpetic and non-herpetic origin. Br J Ophthalmol. 2002; 86:646–52.
crossref
19. Foulks GN. Diagnosis and management of corneal allograft rejection. Krachmer JH, Mannis MJ, Holland EJ, editors. Cornea. St. Louis: Mosby;2005. 2:chap.p. 128.
crossref
20. Rezende RA, Uchoa UB, Raber IM. New onset of herpes simplex virus epithelial keratitis after penetrating keratoplasty. Am J Ophthalmol. 2004; 137:415–9.
crossref
21. Weisbrod DJ, Sit M, Naor J, Slomovic AR. Outcomes of repeat penetrating keratoplasty and risk factors for graft failure. Cornea. 2003; 22:429–34.
crossref
22. Yoon KC, Park YK, Park YG. Surgical results of repeat penetrating keratoplasty and risk factors for graft failure. J Korean Ophthalmol Soc. 2004; 45:1827–32.
23. Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea. 2001; 20:1–13.
crossref
24. Beyer CF, Hill JM, Reidy JJ, Beuerman RW. Corneal nerve disruption reactivates virus in rabbits latently infected with HSV-1. Invest Ophthalmol Vis Sci. 1990; 31:925–32.
25. Beyer CF, Arens MQ, Hill GA, et al. Oral acyclovir reduces the incidence of recurrent herpes simplex keratitis in rabbits after penetrating keratoplasty. Arch Ophthalmol. 1989; 107:1200–5.
crossref
26. Haruta Y, Maguire LJ, Rootman DS, Hill JM. Recurrent herpes simplex virus type 1corneal epithelial lesions after radial keratotomy in the rabbit. Arch Ophthalmol. 1987; 106:692–4.
27. Remeijer L, Maertzdorf J, Buitenwerf J, et al. Corneal herpes simplex virus type 1 superinfection in patients with recrudescent herpetic keratitis. Invest Ophthalmol Vis Sci. 2002; 43:358–63.
28. Haruta Y, Rootman DS, Xie LX, et al. Recurrent HSV-1 corneal lesions in rabbits induced by cyclophosphamide and dexamethasone. Invest Ophthalmol Vis Sci. 1989; 30:371–6.
29. Sudesh S, Cohen EJ, Rapuano CJ, Wilson RP. Corneal toxicity associated with latanoprost. Arch Ophthalmol. 1999; 117:539–40.
crossref
30. Nishiyama Y, Rapp F. Regulation of persistent infection with herpes simplex virus in vitro by hydrocortisone. J Virol. 1979; 31:841–4.
crossref
31. Holbach LM, Bayer J, Seitz B, et al. Herpes simplex keratitis. On the long-term prognosis of first transplants after penetrating keratoplastyaccommodative. Ophthalmologe. 1993; 90:698–702.
32. Schwab IR. Oral acyclovir in the management of herpes simplex ocular infections. Ophthalmology. 1988; 95:423–30.
crossref
33. Jones BR, Fison PN, Cobo ML, et al. Efficacy of acycloguanosine (Wellcome 248u) against herpes simplex ulceration. Lancet. 1979; 1:243–4.
34. Brik D, Dunkel E, Pavan-Langstone D. Herpetic keratitis: persistence of viral particles despite of topical and systemic antiviral therapy. Arch Ophthalmol. 1993; 111:522–7.
35. Foster CS, Barney NP. Systemic acyclovir and penetrating keratoplastyaccommodative for herpes simplex keratitis. Doc Ophthalmol. 1992; 80:363–9.

Table 1.
Comparison of patient characteristics between the recurrent and non-recurrent herpes simplex keratitis groups after penetrating keratoplasty
Characteristics Recurrent Non-recurrent p
Number (eyes/patients) 37/24 41/26
Gender 1.000
Male (eyes/patients) 26/15 28/17
Female (eyes/patients) 11/9 13/9
Age (years) 54.89±11.68 55.59±13.04 0.806
Previous keratoplasty
No. of eyes (%) 20 (54.1) 20 (48.8) 0.812
Frequency (times) 1.03±1.46 0.95±1.32 0.811
Previous graft failure due to recurrent HSK*
No. of eyes (%) 13 (35.1) 4 (9.8) 0.015†
Initial visual acuity (LogMAR) 2.39±0.79 2.58±0.76 0.285
Initial intraocular pressure (mmHg) 13.70±3.76 16.22±7.06 0.051
Preoperative inflammation
No. of eyes (%) 22 (59.5) 14 (34.1) 0.044†
Preoperative corneal neovascularization
No. of eyes (%) 31 (83.8) 30 (73.2) 0.390
Grade 2.22±0.67 2.22±0.76 0.984
Doner (domestic/imported)
No. of eyes (%) 30 (81.1)/7 (18.9) 32 (78.0)/9 (22.0) 0.960
Graft size (mm) 7.74±0.29 7.83±0.40 0.252
Suture methods (Interrupted/Mixed)
No. of eyes (%) 34 (91.9)/3 (8.1) 40 (97.6)/1 (2.4) 0.341
Combined operation
No. of eyes (%) 4 (10.8) 11 (26.8) 0.132
Antiviral prophylaxis (%)
No. of eyes (%) 18 (48.6) 22 (53.7) 0.830
Follow up (months) 34.05±22.53 29.83±20.30 0.699

* HSK=herpes simplex keratitis

† Chi-square test.

Table 2.
Comparison of outcomes after penetrating keratoplasty between the recurrent and non-recurrent herpes simplex keratitis groups
Results Recurrent Non-recurrent p
Final visual acuity (LogMAR) 2.47±0.76 2.42±0.90 0.803
Final intraocular pressure (mm Hg) 14.32±4.90 15.93±7.79 0.286
Rejection rate (%)
1 year 48.6 48.8 1.000
2 years 56.8 63.4 0.713
Final 78.4 68.3 0.455
Rejection frequency (times) 1.03±0.83 1.27±1.03 0.339
Survival rate (%)
1 year 70.3 65.9 0.862
2 years 59.5 53.7 0.774
Final 24.3 24.4 1.000
Survival period (months) 28.42±22.23 24.82±20.23 0.457
Table 3.
Multivariate analysis of risk factors for recurrent herpes simplex keratitis after penetrating keratoplast
Variables in regression model Odds ratio 95 % CI* p
Previous keratoplasty
Present vs. Absent 0.288 0.064–1.306 0.107
Previous graft failure due to recurrent HSK†
Present vs. Absent 7.884 1.405–44.242 0.019
Preoperative inflammation
Present vs. Absent 6.129 1.673–22.447 0.006
Preoperative corneal neovascularization
Present vs. Absent 1.869 0.430–8.121 0.404
Graft size(mm)
≤7.25 vs. >7.25 1.751 0.105–29.274 0.697
≤7.50 vs. >7.50 1.575 0.353–7.024 0.551
≤7.75 vs. >7.75 0.481 0.102–2.273 0.356
≤8.00 vs. >8.00 0.536 0.069–4.175 0.551
Suture methods
Interrupted vs. Mixed 9.479 0.609–147.492 0.108
Antiviral prophylaxis
Performed vs. Not performed 1.738 0.557–5.426 0.341

* CI=confidence interval

† HSK=herpes simplex keratitis.

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