Oral acyclovir after penetrating keratoplasty for herpes simplex keratitis

Objective: To determine the efficacy of systemic acyclovir in decreasing co mplications and improving the outcome of penetrating keratoplasty for herpe s simplex virus (HSV) keratitis. Methods: Retrospective study of 53 primary penetrating keratoplasties for H SV keratitis at an eye hospital from January 1, 1989, through December 31, 1996. Medical records were analyzed for history of HSV keratitis, preoperat ive neovascularization, and disease activity. Postoperative use of acyclovi r, recurrence of HSV keratitis, rejection, uveitis or edema, and graft fail ure were evaluated. Results: Twenty-four patients (mean +/- SD follow-up, 44.7 +/- 32.6 months) received no acyclovir and were compared with 20 patients, (mean +/- SD fol low-up, 28.8 +/- 16.7 months), who received 400 mg acyclovir twice a day fo r at least 1 year. No patient in the acyclovir group had a recurrence of de ndritic keratitis in the first year compared with 5 (21%) of the patients w ho did not receive acyclovir (P=.03). No patient had graft failure in the a cyclovir group compared with 4 (17%) in the group without acyclovir after 1 year of follow-up (P=.06). Conclusion: Postoperative systemic acyclovir therapy after penetrating kera toplasty for HSV keratitis is associated with a reduced rate of recurrent H SV dendritic keratitis and possible graft failure at 1 year bf follow-up.