Researchers have discovered that, even though corneal complications after herpes zoster ophthalmicus (HZO) present a higher risk for graft failure and other postoperative complications, penetrating keratoplasty (PKP) is a reasonable option to improve visual acuity in patients. They also found that long-term visual potential may be limited by comorbid ocular diseases and prophylactic postoperative oral acyclovir did not improve outcomes.
A retrospective review of a large cohort of patients with HZO who underwent PKP looked at the long-term outcomes, including visual acuity and graft survival. Of the 53 patients examined, the quiescent period between active zoster keratitis and PKP was an average of 6.5 ± 5.3 years, and postoperative follow-up averaged 4.0 ± 3.8 years. While the researchers expected the cohort to be at increased risk of graft failure at baseline given a high rate of preoperative corneal hypoesthesia and neovascularization, graft survival remained favorable throughout follow-up, with 75% survival at five years, excluding eyes that underwent tectonic grafts. The mean visual acuity was significantly improved one year after PKP but was not sustained over long-term follow-up.
The study found acyclovir’s ability to improve graft survival was unclear, but suggests that a longer quiescent waiting period before PKP may improve graft survival after surgery. Researchers concluded that practitioners should choose surgical candidates conservatively, operate on quiet eyes whenever possible, monitor the patient closely after surgery and assiduously treat postoperative inflammation and ocular surface problems.
|Tanaka TS, Hood CT, Kriegel MF, et al. Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus. Br J Ophthalmol. February 7, 2019. [Epub ahead of print].|