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.