Surgical management of herpetic keratitis

Tuli, Sonal S.; Gray, Matthew P.; Shah, Ankit

doi:10.1097/icu.0000000000000484

Cited by 21 publications

(5 citation statements)

References 47 publications

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“…Currently, the main treatments of HSK are topical and oral agent antiviral drugs that inhibit the replication of the virus in the cornea . However, in order to preserve the eyeball and recover corneal clarity, surgical intervention may be required for patients with corneal dissolution or long‐term complications such as ulcers, necrotizing keratitis, and neurotrophic keratitis …”

Section: Introductionmentioning

confidence: 99%

“…5 However, in order to preserve the eyeball and recover corneal clarity, surgical intervention may be required for patients with corneal dissolution or long-term complications such as ulcers, necrotizing keratitis, and neurotrophic keratitis. 6 Currently, the lack of donor corneas is a major problem for corneal transplantation especially in Asian countries. 7 Many patients miss the best time for treatment whilst waiting for donor cornea tissue.…”

Section: Introductionmentioning

confidence: 99%

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Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Zheng

Huang

Zhang

et al. 2019

Xenotransplantation

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Background Corneal transplantation is a common surgical intervention for restoring vision loss due to corneal damages. However, for cultural reasons, there is a huge shortage of donor corneas in China. Acellular porcine corneal stromas (APCSs) can be used as corneal substitutes in lamellar keratoplasty for corneal ulcers. This study was conducted to analyze the results of APCS use for herpes simplex keratitis (HSK). Methods The study involved HSK patients who underwent keratoplasty with APCSs from February 2016 to October 2017 in the second affiliated hospital of Zhejiang University. Patient data were collected at 7 days, 1 month, 3 months, 6 months, and at the last follow‐up (7‐25 months) postoperative. The corneal transparency, neovascularization, visual acuity, and graft stability were observed. Results Thirteen patients with HSK including five patients with corneal perforation were included in this study, nine patients underwent deep anterior lamellar keratoplasty (DALK) and five perforation patients underwent double lamellar keratoplasty. There were nine men and four women with an average age of 62.5 ± 5.6 years old (ranging from 52 to 70 years old). The mean postoperative follow‐up duration was 15.1 ± 5.8 months (ranging from 7 to 25 months). At the last visit, visual acuity improved in nine patients (69.2%) compared with preoperative (P = 0.008).The grafts of seven individuals (53.8%) were completely transparent or slightly opaque; their corneal transparency score had improved significantly compared with before the surgery (P = 0.010). Various degrees of neovascularization were present in 11 of the 13 patients (84.6%), most neovascularization gradually stabilized. Graft dissolution occurred in three eyes (23.1%) during the observation period, two underwent regrafting, the other one became stable after treatment. Three patients underwent second allograft transplantation, two of which encountered APCS graft dissolution and one of the patients requested a human donor allograft transplantation due to transparency issues despite the absence of adverse issues. Conclusion Acellular porcine corneal stroma seems to be effective in the treatment of HSK and can be used in HSK with corneal perforation by using double lamellar keratoplasty in an emergency.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Zheng

Huang

Zhang

et al. 2019

Xenotransplantation

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“…Research has found that therapeutic grafts for herpetic keratitis have poor outcomes. In addition to a signi cant rate of rejection and recurrence, hypoesthesia secondary to the loss of nerve cells may provoke exposure keratopathy [24]. Our study included two patients with herpetic keratitis.…”

Section: Discussionmentioning

confidence: 99%

DALK combined intralamellar tectonic patch graft: An alternative approach to treat frank corneal perforation

Xiao,

Ben,

et al. 2023

Preprint

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Background Deep anterior lamellar keratoplasty (DALK) has gained popularity in cases of corneal thinning and leaking descemetocele. In this study, we introduced an intralamellar tectonic patch graft in addition to conventional DALK procedures to treat frank cornea perforation. Methods This retrospective case series included 13 patients (13 eyes) with frank corneal perforations who underwent DALK combined with intralamellar tectonic patch graft between December 2015 and December 2021. In addition to the standard DALK procedure, the perforation site was repaired with an extra intralamellar tectonic patch graft. The collected data included patient demographics, aetiology, size and location of the corneal perforation, visual acuity, surgical details, and postoperative complications. Results Seven patients underwent autologous intralamellar patch grafts, whereas six received allogeneic ones. Anatomical success was achieved in all patients. The mean postoperative follow-up was 33.31 ± 25.96 months (6–73 months). The postoperative visual acuity (0.90 ± 0.65 logMAR) was significantly improved (P = 0.003) compared to the preoperative score (1.74 ± 0.83 logMAR). Best corrected visual acuity (BCVA) improved in 12 eyes (92.3%). The mean endothelial cell density was 2028 ± 463 cells/mm2, 6–12 months postoperatively. There was no recurrence of perforation, and the anterior lamellar graft remained transparent in 12 patients (92.3%). Postoperative complications included epithelial defects (23.1%), ocular hypertension (15.4%), and cataract (7.7%). Conclusions DALK combined with intralamellar tectonic patch graft may serve as a secure and effective alternative in treating frank corneal perforation, with reduced complications compared to conventional penetrating keratoplasty.

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“…Trifluridine (TFT) eye drop, acyclovir (ACV) ointment, ganciclovir (GCV) gel, and oral ACV are still the main therapeutic agents for treatment of ocular HSV infection (Roozbahani and Hammersmith, 2018;Valerio and Lin, 2019). Surgical treatment may be necessary to treat complications arising from HSV keratitis (Tuli et al, 2018). The animal models of HSV vaccine are able to reduce HSV keratitis (Dong et al, 2017;Tang et al, 2018;Royer et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Programmed Cell Death-Dependent Host Defense in Ocular Herpes Simplex Virus Infection

et al. 2022

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Herpes simplex virus type 1 (HSV1) remains one of the most ubiquitous human pathogens on earth. The classical presentation of HSV1 infection occurs as a recurrent lesions of the oral mucosa commonly refer to as the common cold sore. However, HSV1 also is responsible for a range of ocular diseases in immunocompetent persons that are of medical importance, causing vision loss that may result in blindness. These include a recurrent corneal disease, herpes stromal keratitis, and a retinal disease, acute retinal necrosis, for which clinically relevant animal models exist. Diverse host immune mechanisms mediate control over herpesviruses, sustaining lifelong latency in neurons. Programmed cell death (PCD) pathways including apoptosis, necroptosis, and pyroptosis serve as an innate immune mechanism that eliminates virus-infected cells and regulates infection-associated inflammation during virus invasion. These different types of cell death operate under distinct regulatory mechanisms but all server to curtail virus infection. Herpesviruses, including HSV1, have evolved numerous cell death evasion strategies that restrict the hosts ability to control PCD to subvert clearance of infection and modulate inflammation. In this review, we discuss the key studies that have contributed to our current knowledge of cell death pathways manipulated by HSV1 and relate the contributions of cell death to infection and potential ocular disease outcomes.

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Surgical management of herpetic keratitis

Abstract: Several options are available for surgically managing the complications of herpes keratitis. Ophthalmologists should select the optimal procedure based on the individual patient's situation. VIDEO ABSTRACT: http://links.lww.com/COOP/A28.

Cited by 21 publications

References 47 publications

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

Short‐term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis

DALK combined intralamellar tectonic patch graft: An alternative approach to treat frank corneal perforation

Programmed Cell Death-Dependent Host Defense in Ocular Herpes Simplex Virus Infection

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