Therapeutic effect of deep anterior lamellar keratoplasty for active or quiescent herpetic stromal keratitis

Abstract

Purpose: To evaluate the therapeutic effect of deep anterior lamellar keratoplasty (DALK) in patients with herpetic stromal keratitis (HSK).

Methods: Forty-three eyes belonging to 42 patients with HSK, including 22 eyes in the active phase and 21 eyes in the quiescent phase, underwent DALK at the Shandong Eye Institute from January 2006 to December 2009. All patients with active disease had received intravenous acyclovir and amniotic membrane implants prior to DALK. Herpes simplex virus type 1 (HSV-1) antigens from excised corneal buttons were detected by immunohistochemistry.

Results: The follow-up ranged from 1 to 4 years (mean, 29.1 months). Graft rejection occurred in one eye (2.3%) and was reversed. Among the other 42 survived grafts (97.7%), 37 remained clear at the last visit. The best spectacle-corrected visual acuity was 20/200 or better in 95.2% of eyes and 20/40 or better in 38.1% of eyes. Six eyes (14.0%) developed recurrent HSK, one of which received a second keratoplasty due to ineffective antiviral medication. There were no significant differences in endothelial cell density between 6 months and 12 months after the surgery. By immunohistochemistry, HSV-1 antigens were observed in the stroma of 18 of 32 corneal buttons.

Conclusions: DALK can not only remove the corneal lesions of HSK but also reduce latent or persistent viral loads in the cornea. In eyes with active or quiescent HSK but otherwise healthy endothelia, DALK seems to be safe and promising for its favorable visual outcome, graft survival rate, and low endothelial cell loss.