Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus.

Autor:	Tanaka TS; W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.; Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil., Hood CT; W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA hoodc@med.umich.edu., Kriegel MF; W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.; Department of Ophthalmology, St Franziskus-Hospital, Muenster, Germany., Niziol L; W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA., Soong HK; W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.
Jazyk:	angličtina
Zdroj:	The British journal of ophthalmology [Br J Ophthalmol] 2019 Dec; Vol. 103 (12), pp. 1710-1715. Date of Electronic Publication: 2019 Feb 07.
DOI:	10.1136/bjophthalmol-2018-313602
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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