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Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus
  1. Thaís Shiota Tanaka1,2,
  2. Christopher Thomas Hood1,
  3. Matthias Frank Kriegel1,3,
  4. Leslie Niziol1,4,
  5. H Kaz Soong1
  1. 1 W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
  3. 3 Department of Ophthalmology, St Franziskus-Hospital, Muenster, Germany
  4. 4 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Christopher Thomas Hood, Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 48105, USA; hoodc{at}


Background/Aim To review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).

Methods We reviewed the medical records of 53 eyes of 53 patients who underwent PKP due to corneal complications of HZO at the Kellogg Eye Center.

Results The mean age of patients at the time of PKP was 68.0±16.4 years, with a follow-up of 4.0±3.8 years and quiescent period of 6.5±5.3 years from active HZO to PKP. Preoperatively, 25 (47.2%) eyes were completely anaesthetic, while 16 (30.2%) had deep corneal neovascularisation in four quadrants. Comorbid ocular disease, including cataract, glaucoma and macular disease, was present in 25 (47.2%) eyes. Twenty patients (37.8%) received acyclovir for the entire postoperative period. There were no recurrences of zoster keratitis in any eye. The most common complications were difficulty healing the ocular surface (12/53, 22.6%) and glaucoma (14/53, 26.4%). Thirty per cent of the eyes required one or more additional postoperative procedures, most commonly tarsorrhaphy (10/53, 18.9%) and amniotic membrane graft (6/53, 11.3%). At 1, 2–4 and ≥5 years, 94%, 82% and 70% grafts remained clear, respectively. Visual acuity improved at 1 year postoperatively (p<0.0001), but this improvement was not sustained. There was no significant benefit of long-term acyclovir on visual acuity (p=0.2132) or graft survival (p=0.241).

Conclusions Even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favourable tectonic and visual results. Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases. Prophylactic postoperative oral acyclovir did not improve outcomes.

  • cornea
  • infection
  • inflammation
  • zoster

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  • TísST and CTH contributed equally.

  • Contributors All authors were involved in the data collection, analysis and interpretation, as well as in manuscript drafting, editing and approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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