|Year : 1979 | Volume
| Issue : 3 | Page : 1-5
Therapeutic keratopiasty in herpetic keratitis
Dhanwant Singh, DPS Sandhu
Government Medical College and Rajendra Hospital, Patiala (Punjab), India
Department of Ophthalmology, Government Medical College and Rajendra Hospital, Patiala147001 (Punjab)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D, Sandhu D. Therapeutic keratopiasty in herpetic keratitis. Indian J Ophthalmol 1979;27:1-5
In the recent past the incidence of herpetic keratitis in India is on the increase because of rise in the number of malaria cases. Unfortunately there is no effective medicinal treatment for it. This study has been undertaken to judge the success of therapeutic keratoplasty in herpetic keratitis; in regard of recurrence and to retain the useful vision in seventeen cases admitted in this hospital during one year with follow up period upto three years.
| Material And Methods|| |
Following tables show the type of cases selected and the type of grafting done.
In ten cases of herpetic keratitis repeated iodine cautery was done alongwith usual treatment of ulcer. In six cases Ridinox (IDU) drops were tried one hourly in day time and two hourly at night time for an available period varying from nine days to two weeks but without result, [Table - 4].
The size of the corneal trephine was so selected as to include the whole of the diseased cornea. Dissection for lamellar grafts was done as deep as possible. No case had perforation of the bed during dissection. 8-0 virgin silk interrupted sutures were applied, each 1.5mm. apart. Air was injected in penetrating grafts.
Cases of herpetic keratitis which showed residual infection in the graft bed in the form of fine grey dots were post-operatively put on Ridinox drops six times a day with Betnesol-N eye drops three times a day (Case 2, 4, 8, 9, 10, 11, 12 and 15). This regime was carried out for six weeks.
| Observations|| |
Fifteen cases were treated with lamellar graft and two with penetrating graft. There was marked visual improvement in all the cases of lamellar grafts, [Table - 4]. All the grafts remained clear and transparent [Figure - 1]a, b.
Recurrence of herpetic keratitis was seen in nine cases. The earliest signs of recurrence were oedema, punctate dots in the graft bed and slight puckering on the graft. In one case (Case 15) recurrence developed from the graft margin. Epithelial ulcer was not seen in any of the cases with recurrences. These patients were put on Ridinox-Betnesol-N combined therapy and the disease cleared up in all the cases within one to two weeks but the treatment was continued for six- weeks with gradual tapering of medicines. All the nine grafts remained clear, [Figure - 2]a and b.
The complications are shown in [Table - 3].
| Discussion|| |
Out of fifteen cases of lamellar keratoplasty immediate post-operative recurrence developed in seven cases (46.7%) within the first eighteen days of operation. This high incidence was due to the fact that the corneal grafting was undertaken in active stage of disease and some of the viral particles would have been left in keratocytes within the stroma. In two cases recurrences developed after about ten weeks of operation (13.3%). In two separate studies, the recurrence rate in non-grafted corneas was 43% in two years for epithelial herpes, and 84% for epithelial and stromal herpes.
Recurrence of herpetic keratitis was controlled in all the cases (100%). None of these grafts developed any further recurrence in next two to three years of follow up. Inspite of the recurrence, the visual improvement was fairly good, [Table - 4]. The uncorrected visual acuity was 6/36 to 6/60 in seven cases and FC at three meters in two cases. This is in contrast to the reports by Pfister et a1, that once the recurrence develops, the changes of graft remaining clear are remote.
Dendritic recurrence was frequent in first two months of the surgery. So topical corticosteroids alongwith IDU are recommended postoperatively in every case where there is slightest doubt of residual herpetic inflammation. Corticosteroids should be reduced rapidly to the lowest level while maintaining the use of IDU for as long as six weeks which helps in clearing the stromal lesions as well.
Penetrating keratoplasty in active corneal herpes is required where the lesion is deep. The present study includes only two cases of penetrating keratoplasty. Both the grafts remained clear and no post-operative recurrence was noticed in any of the cases. But the number of cases is too less to give any statistic evaluation.
The complications of lamellar keratoplasty in active herpetic keratitis are few and manageable. This is in contrast to the statement of Polack and Kaufmann who were dissatisfied with lamellas keratoplasty because of vascularization, scarring and necrosis of the grafts.
| Summary and conclusions|| |
Therapeutic keratoplasty was undertaken in seventeen cases of viral keratitis. Nine cases (all LKP) had herpetic recurrence within ten weeks of the operation, which disappeared with topical use of IDU and Betnesol-N eye drops. Inspite of the recurrence all the grafts remained clear and there was great improvement in visual acuity and no further recurrence occurred upto three years of follow up.
| References|| |
Aronson, S.B., 1972, Amer. Jour. Ophthal., 73, 192.
Carroll, J.M., Martola, E.L., Laibson, P.R. and Dohlman, C.H., 1967, Amer. Jour. Ophthal., 63,
Pfister, R., Richard, S.F., and Dohlman, H., 1972, Amer. Jour. Ophthal., 73, 192.
Polack, F.M. and Kaufmann, H.E., 1972, Amer. Jour. Ophthal., 73, 908.
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]