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. 2018 Oct 22:2018:4351460.
doi: 10.1155/2018/4351460. eCollection 2018.

Characteristics of New Onset Herpes Simplex Keratitis after Keratoplasty

Xiaolin Qi  1 , Miaolin Wang  1 , Xiaofeng Li  1 , Yanni Jia  1 , Suxia Li  1 , Weiyun Shi  1 , Hua Gao  1
Affiliations

Characteristics of New Onset Herpes Simplex Keratitis after Keratoplasty

Xiaolin Qi et al. J Ophthalmol. .

Abstract

Purpose: To observe clinical characteristics and treatment outcomes of new onset herpes simplex keratitis (HSK) after keratoplasty.

Methods: Among 1,443 patients (1,443 eyes) who underwent keratoplasty (excluding cases of primary HSK) in Shandong Eye Hospital, 17 patients suffered postoperative HSK. The clinical manifestations, treatment regimens, and prognoses of the patients were evaluated.

Results: The incidence of new onset HSK after keratoplasty was 1.18%. Epithelial HSK occurred in 10 eyes, with dendritic epithelial infiltration in 6 eyes and map-like epithelial defects in 4 eyes. Nine eyes had lesions at the junction of the graft and recipient. Stromal necrotic and endothelial HSK occurred in 7 eyes, presenting map-shaped ulcers in the entire corneal graft and recipient (two eyes) or at the graft-recipient junction (five eyes). Confocal microscopy revealed infiltration of a large number of dendritic cells at the junction of the lesion and transparent cornea. All 10 eyes with epithelial lesions and two eyes suffering stromal lesions of ≤1/3 corneal thickness healed after systematic and local antiviral treatment. Best-corrected visual acuity and corneal graft transparency were restored. For stromal HSK with an ulcer of >1/3 corneal thickness, amniotic membrane transplantation was performed, and visual acuity and graft transparency decreased significantly.

Conclusion: New onset HSK after keratoplasty primarily resulted in epithelial and stromal lesion, involving both the graft and recipient. Effective treatments included antiviral medications and amniotic membrane transplantation. Delayed treatment may lead to aggravated graft opacification.

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Figures

Figure 1
Figure 1
Slit lamp examination of patient 1 with epithelial HSK. (a) Two years after deep anterior lamellar keratoplasty for corneal leucoma. (b) Dendritic epithelial infiltration, terminal expansion, and positive fluorescein sodium staining at 2 and 10o'clock and the junction of the graft and recipient. (c) Epithelial infiltration disappearance after systemic and local antiviral treatment. (d) Negative fluorescein sodium staining.
Figure 2
Figure 2
Slit lamp examination of patient 2 with epithelial HSK. (a) Two months after penetrating keratoplasty for bacterial corneal ulcers. (b) Map-shaped fluorescein sodium staining at the junction of the graft and recipient between 9 and 1o'clock. (c) The healed epithelium and clear cornea after systemic and local antiviral treatment. (d) Negative fluorescein sodium staining.
Figure 3
Figure 3
Slit lamp examination of patient 3 with stromal necrotic and endothelial HSK. (a) The edematous corneal graft at 6 months after penetrating keratoplasty for fungal corneal ulceration. (b) Map-shaped ulceration at the junction of the graft and recipient between 10 and 3o'clock. (c) The healed ulcer and clear cornea after systemic and local antiviral treatment. (d) Negative fluorescein sodium staining.
Figure 4
Figure 4
Slit lamp examination of patient 4 with stromal necrotic and endothelial HSK. (a) The edematous corneal graft at one and a half years after penetrating keratoplasty for bacterial corneal ulceration. (b) Map-shaped ulceration at the junction of the graft and recipient between 10 and 2o'clock. (c) The ulcer healing after amniotic membrane transplantation. (d) The corneal clarity was decreased.
Figure 5
Figure 5
Slit lamp examination of patient 4 with stromal necrotic and endothelial HSK. (a) Corneal graft edema and opacity at one and a half years after penetrating keratoplasty for bacterial corneal ulceration. (b) Fluorescein sodium staining displaying ulceration of the entire corneal graft involving the whole transplant bed. (c) The ulcer healing after double amniotic membrane transplantation. (d) The residual amniotic membrane at the final follow-up. The corneal clarity was decreased significantly.
Figure 6
Figure 6
In vivo confocal microscopy examination of epithelial HSK. (a) The epithelial cells were swollen and necrotic. (b) A large number of dendritic cells were observed at the junction of the lesion and transparent cornea. (c) The polygonal cells of the stromal cells in the superficial stromal layer showed enhanced reflectivity and were arranged in a cross-hatched pattern. (d) Little KPs were observed in the endothelial cell layer.
Figure 7
Figure 7
In vivo confocal microscopy examination of stromal necrotic and endothelial HSK. (a) Scanning images of the stromal cells were unclear. (b) A large amount of inflammatory cells were observed. (c) A large number of dendritic cells were observed, and wire netting was formed via long interdigitating dendrites at the junction of the lesion and transparent cornea. (d) Lots of KPs were observed in the endothelial cell layer.
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