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Br J Ophthalmol 2002;86:646-652 doi:10.1136/bjo.86.6.646
  • Original Article

The outcome of corneal grafting in patients with stromal keratitis of herpetic and non-herpetic origin

  1. M Halberstadt1,
  2. M Machens1,
  3. K-A Gahlenbek2,
  4. M Böhnke1,
  5. J G Garweg1
  1. 1Department of Ophthalmolgy, University of Bern, Inselspital, CH-3010 Bern, Switzerland
  2. 2Private Practice, Hamburg, Germany
  1. Correspondence to: Justus G Garweg, MD, Department of Ophthalmolgy, University of Bern, Inselspital, CH-3010 Bern, Switzerland; justus.garweg{at}insel.ch
  • Accepted 18 December 2001

Abstract

Aim: 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).

Conclusion: 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.

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