Deep Anterior Lamellar Deep Anterior Lamellar Keratoplasty in Herpes Keratoplasty in Herpes

Simplex Corneal OpacitiesSimplex Corneal Opacities

V. SarnicolaV. Sarnicola

ItalyItaly

ASCRS-ASOA ANNUAL MEETINGASCRS-ASOA ANNUAL MEETINGBoston April 9-14, 2010Boston April 9-14, 2010

Financial DisclosureFinancial Disclosure

Author have no financial interest or relationships to Author have no financial interest or relationships to disclose disclose

PurposePurpose

● To report our experience with deep anterior

lamellar keratoplasty (DALK) for the

treatment of corneal opacities following

herpetic keratitis.

Materials and MethodsMaterials and Methods

• Cases report study

• 52 eyes with post-herpetic stromal scars of

52 patients (2002 - 2006)

• Average follow-up : 31 months

• Mean age: 46,5 yrs (range 35-60 yrs)

Materials and MethodsMaterials and Methods

• Descemet membrane reachedDescemet membrane reached

• Intra and postoperative complications Intra and postoperative complications

• Pre and postop. visual acuityPre and postop. visual acuity

• Endothelial cell densityEndothelial cell density

• Therapeutic protocolTherapeutic protocol

• Recurrence of HSV keratitis/rejectionRecurrence of HSV keratitis/rejection

Antiviral prophylaxis Antiviral prophylaxis

• Acyclovir 800 mg/dayAcyclovir 800 mg/day

• Corticosteroids drops once a dayCorticosteroids drops once a day

• Patients without episodes of recurrence Patients without episodes of recurrence

for 1 year for 1 year

52 DALK after HSV- 2002/200652 DALK after HSV- 2002/2006

NoNo

NoNo

NoNo

2/522/52

(4%)(4%)

7/527/52

(13,5%)(13,5%)

45/5245/52

(86,5%)(86,5%)

Conversion to PKPConversion to PKP

Double chamberDouble chamber

MacroperfMacroperf

MicroperfMicroperf

PredescemeticPredescemetic

DescemeticDescemetic

ResultsResults

Descemet membrane Descemet membrane ExposureExposure

Descemet membrane Descemet membrane ExposureExposure

DESCEMETIC DESCEMETIC (dDALK 86,5 %)(dDALK 86,5 %)

PRE-DESCEMETICPRE-DESCEMETIC

(pdDALK 13,5%)(pdDALK 13,5%)

Visual acuity

0020/10020/100

0020/8020/80

1 (2%)1 (2%)20/7020/70

2 (4%)2 (4%)20/6020/60

2 (4%)2 (4%)20/5020/50

5 (10%)5 (10%)20/4020/40

9 (17%)9 (17%)20/3020/30

6 (11%)6 (11%)20/2520/25

27 (27 (52%52% ) )20/2020/20

Number/% of Number/% of patients patients

BCVABCVA

Endothelial Cell Count 25/52 Endothelial Cell Count 25/52

Average of endothelial cell countAverage of endothelial cell countAverage of endothelial cell countAverage of endothelial cell count

2272 cel/mm22272 cel/mm22375 cel/mm22375 cel/mm2Endothelial Cell Endothelial Cell DensityDensity

12 months12 months6 months6 monthsFollow-upFollow-up

CONCLUSIONSCONCLUSIONS

• Therapy goals:Therapy goals:

• Virus proliferation control/erradicationVirus proliferation control/erradication

• Systemic antiviralSystemic antiviral

• Immune response modulationImmune response modulation

• Local and general steroidsLocal and general steroids

DALK in post Herpetic DALK in post Herpetic corneal scarscorneal scars

PreopPreop PostopPostop