Chapter 13. Problems of Corneal Grafting in Herpetic Keratitis

  1. Ruth Porter and
  2. Julie Knight
  1. N. S. C. Rice and
  2. Barrie R. Jones

Published Online: 30 MAY 2008

DOI: 10.1002/9780470719985.ch13

Ciba Foundation Symposium 15 - Corneal Graft Failure

Ciba Foundation Symposium 15 - Corneal Graft Failure

How to Cite

Rice, N. S. C. and Jones, B. R. (1973) Problems of Corneal Grafting in Herpetic Keratitis, in Ciba Foundation Symposium 15 - Corneal Graft Failure (eds R. Porter and J. Knight), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470719985.ch13

Author Information

  1. Department of Clinical Ophthalmology, Institute, of Ophthalmology, London

Publication History

  1. Published Online: 30 MAY 2008
  2. Published Print: 1 JAN 1973

ISBN Information

Print ISBN: 9789021940168

Online ISBN: 9780470719985

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Keywords:

  • antiviral drugs;
  • corneal grafting;
  • herpetic keratitis;
  • corneal transplantation;
  • lamellar grafts

Summary

The results of corneal grafts performed on eyes with herpetic keratitis have been analysed. Lamellar grafts were associated with a high incidence of recurrence of stromal keratitis (64.7%). Herpes virus particles in the host stroma deep to lamellar grafts have been demonstrated by electron microscopy. 35.3 % of eyes receiving lamellar grafts developed recurrences of herpetic epithelial keratitis.

The overall success rate of penetrating keratoplasty was 78 %; the rates in eyes which were respectively clinically active and inactive at the time of surgery were almost the same (77 % and 79 %). 57.9 % of penetrating grafts developed oedema of the graft and uveitis, the incidence being higher in active cases (63.6%) than in inactive cases (54.3 %); half the grafts in each group cleared with corticosteroid therapy. The pathogenesis of this phenomenon is discussed. Previous lamellar keratoplasty was associated with a high rate of failure (55.6%) of subsequent penetrating grafts. 8.8 % of eyes receiving penetrating grafts developed recurrence of herpetic epithelial keratitis. Antiviral drugs administered to eyes after keratoplasty are toxic to the corneal epithelium and lead to epithelial keratopathy of grafts; the routine use of these agents in postoperative management is not recommended.