Follow-up analysis of penetrating planned keratoplasties and emergency keratoplasties in herpes eyes

Background: We evaluated in this retrospective study the impact of our diagnostic and therapeutic regimens - as illustrated by typical clinical pictures - on the frequency and prognostic values of postkeratoplasty complications in herpes eyes. Patients and methods: Between November 1986 and June 1994, 112 penetrating keratoplasties (KPS) in herpes eyes were performed, 76 as planned and 36 as emergency procedures. The results were compared with 646 KPS with normal risk. For statistical analysis we used the Kaplan-Meier estimation, and statistical significance was tested by the log rank test. Results: After 6 years, 75 % of the grafts in the planned herpes group, 86 % of the a chaud KPS and 76 % of the grafts of the normal-risk group were still clear without significant differences between these three groups. Fifty-four percent of the planned KPS in herpes eyes, 73 % of the a chaud KPS in herpes eyes and 80 % of the normal-risk KPS experienced no immune reaction, with bath herpes groups showing significantly more reactions than the normal-risk KPS. There was, however, no significant difference in immune reactions between the two herpes groups. The percentage of grafts with recurrence of herpes simplex virus infection after 6 years was significantly higher in the a chaud group. Conclusions: With proper postoperative care and optimal management of immunologic and virologic complications - but only with this! - the prognosis of penetrating keratoplasties in herpes eyes equals that of normal risk eyes. An particular, the prognosis is not dependent on whether surgery was performed as a planned or as an emergency procedure.