Tags

Type your tag names separated by a space and hit enter

[Deep anterior lamellar keratoplasty combined with antiviral therapy in the treatment of severe herpes necrotizing stromal keratitis].
Zhonghua Yan Ke Za Zhi 2018; 54(2):97-104ZY

Abstract

Objective:

To evaluate the efficacy of modified deep lamellar keratoplasty (DLKP) combined with antiviral medications for severe herpes necrotizing stromal keratitis.

Methods:

Retrospective case series study. Modified DLKP was performed in combination with antiviral medications in fifty patients (50 eyes) with severe necrotizing stromal keratitis, which was unresponsive to systemic and topical antiviral treatment for 1 week, at Shandong Eye Hospital. Before surgery, the operated eyes were examined using slit-lamp microscopy. The size of corneal ulceration and inflammatory infiltration and the depth of ulceration were observed in all of the patients. Corneal scraping and microbial culture and confocal laser scanning microscopy were used to exclude fungal, bacterial, Acanthamoeba, or other infections, and check the number of corneal endothelial cells. Anterior segment optical coherence tomography was used to examine the depth of infiltration, especially the thickness of the remaining cornea below the deepest ulceration. Antiviral drugs were used topically and systemically to control the infection and inflammation. Postoperatively, both antiviral drugs and low-dose corticosteroids were used. The ocular inflammation, corneal graft status and viral recurrence were monitored intraoperatively and postoperatively.

Results:

All of the fifty patients showed obvious inflammatory infiltration and stromal ulcers, and the corneal stroma in 23 patients (46%) remained less than 1/5 of the corneal thickness. Nine (18%) of the patients presented with descemetocele. The depth of infiltration ranged from 128 μm to 519 μm [mean, (265±84) μm]. The depth of corneal ulcers was deeper than 2/3 of the corneal thickness in 36 eyes (72%). The endothelial cells were visible in 26 eyes. The density of endothelial cells ranged from 1 275 cells/mm(2) to 2 994 cells/mm(2) [mean, (2 053±507) cells/mm(2)]. No fungal or bacterial infection was detected by corneal scraping. The microbial culture results were negative. All the inflammations in patients with severe herpes necrotizing stromal keratitis were under control by DLKP. No intraoperative corneal perforation occurred, and 6 eyes (12%) healed following amniotic membrane transplantation due to slow corneal epithelial healing. The infection was exacerbated two days following the surgery in two eyes (4%). These infections were controlled with enhanced antiviral medications in addition to the immediate withdrawal of corticosteroids. The corneal grafts returned to transparency at 1-2 weeks in 42 eyes (84%). Ten eyes (20%) exhibited recurrence due to medication withdrawal without the doctors' advice and a lack of regular visit during 2-year follow-up. Two patients (4%) developed stromal graft rejection for the same reasons.

Conclusions:

DLKP can achieve the results of ulcer healing for severe herpes necrotizing stromal keratitis. Combined antiviral therapy and close follow-up can reduce the viral recurrence. (Chin J Ophthalmol, 2018, 54: 97-104).

Authors+Show Affiliations

Shandong Eye Hospital, Shandong Eye Institute, Jinan 250021, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

chi

PubMed ID

29429293

Citation

Li, S X., et al. "[Deep Anterior Lamellar Keratoplasty Combined With Antiviral Therapy in the Treatment of Severe Herpes Necrotizing Stromal Keratitis]." [Zhonghua Yan Ke Za Zhi] Chinese Journal of Ophthalmology, vol. 54, no. 2, 2018, pp. 97-104.
Li SX, Wang JT, Jiang Y, et al. [Deep anterior lamellar keratoplasty combined with antiviral therapy in the treatment of severe herpes necrotizing stromal keratitis]. Zhonghua Yan Ke Za Zhi. 2018;54(2):97-104.
Li, S. X., Wang, J. T., Jiang, Y., Wang, X., & Shi, W. Y. (2018). [Deep anterior lamellar keratoplasty combined with antiviral therapy in the treatment of severe herpes necrotizing stromal keratitis]. [Zhonghua Yan Ke Za Zhi] Chinese Journal of Ophthalmology, 54(2), pp. 97-104. doi:10.3760/cma.j.issn.0412-4081.2018.02.006.
Li SX, et al. [Deep Anterior Lamellar Keratoplasty Combined With Antiviral Therapy in the Treatment of Severe Herpes Necrotizing Stromal Keratitis]. Zhonghua Yan Ke Za Zhi. 2018 Feb 11;54(2):97-104. PubMed PMID: 29429293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Deep anterior lamellar keratoplasty combined with antiviral therapy in the treatment of severe herpes necrotizing stromal keratitis]. AU - Li,S X, AU - Wang,J T, AU - Jiang,Y, AU - Wang,X, AU - Shi,W Y, PY - 2018/2/13/entrez PY - 2018/2/13/pubmed PY - 2019/6/22/medline KW - Corneal transplantation KW - Drug therapy KW - Keratitis, herpetic KW - Recurrence SP - 97 EP - 104 JF - [Zhonghua yan ke za zhi] Chinese journal of ophthalmology JO - Zhonghua Yan Ke Za Zhi VL - 54 IS - 2 N2 - Objective: To evaluate the efficacy of modified deep lamellar keratoplasty (DLKP) combined with antiviral medications for severe herpes necrotizing stromal keratitis. Methods: Retrospective case series study. Modified DLKP was performed in combination with antiviral medications in fifty patients (50 eyes) with severe necrotizing stromal keratitis, which was unresponsive to systemic and topical antiviral treatment for 1 week, at Shandong Eye Hospital. Before surgery, the operated eyes were examined using slit-lamp microscopy. The size of corneal ulceration and inflammatory infiltration and the depth of ulceration were observed in all of the patients. Corneal scraping and microbial culture and confocal laser scanning microscopy were used to exclude fungal, bacterial, Acanthamoeba, or other infections, and check the number of corneal endothelial cells. Anterior segment optical coherence tomography was used to examine the depth of infiltration, especially the thickness of the remaining cornea below the deepest ulceration. Antiviral drugs were used topically and systemically to control the infection and inflammation. Postoperatively, both antiviral drugs and low-dose corticosteroids were used. The ocular inflammation, corneal graft status and viral recurrence were monitored intraoperatively and postoperatively. Results: All of the fifty patients showed obvious inflammatory infiltration and stromal ulcers, and the corneal stroma in 23 patients (46%) remained less than 1/5 of the corneal thickness. Nine (18%) of the patients presented with descemetocele. The depth of infiltration ranged from 128 μm to 519 μm [mean, (265±84) μm]. The depth of corneal ulcers was deeper than 2/3 of the corneal thickness in 36 eyes (72%). The endothelial cells were visible in 26 eyes. The density of endothelial cells ranged from 1 275 cells/mm(2) to 2 994 cells/mm(2) [mean, (2 053±507) cells/mm(2)]. No fungal or bacterial infection was detected by corneal scraping. The microbial culture results were negative. All the inflammations in patients with severe herpes necrotizing stromal keratitis were under control by DLKP. No intraoperative corneal perforation occurred, and 6 eyes (12%) healed following amniotic membrane transplantation due to slow corneal epithelial healing. The infection was exacerbated two days following the surgery in two eyes (4%). These infections were controlled with enhanced antiviral medications in addition to the immediate withdrawal of corticosteroids. The corneal grafts returned to transparency at 1-2 weeks in 42 eyes (84%). Ten eyes (20%) exhibited recurrence due to medication withdrawal without the doctors' advice and a lack of regular visit during 2-year follow-up. Two patients (4%) developed stromal graft rejection for the same reasons. Conclusions: DLKP can achieve the results of ulcer healing for severe herpes necrotizing stromal keratitis. Combined antiviral therapy and close follow-up can reduce the viral recurrence. (Chin J Ophthalmol, 2018, 54: 97-104). SN - 0412-4081 UR - https://www.unboundmedicine.com/medline/citation/29429293/[Deep_anterior_lamellar_keratoplasty_combined_with_antiviral_therapy_in_the_treatment_of_severe_herpes_necrotizing_stromal_keratitis]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&issn=0412-4081&year=2018&vol=54&issue=2&fpage=97 DB - PRIME DP - Unbound Medicine ER -