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Five-Year Follow-Up on the Effect of Oral Acyclovir After Penetrating Keratoplasty for Herpetic Keratitis

Jansen, Aateke F G MD; Rijneveld, Wilhelmina J MD; Remeijer, Lies MD, PhD; Völker-Dieben, Henny J M MD, PhD; Eggink, Catharina A MD, PhD; Geerards, Annette J M MD; Mulder, Paul G H PhD; Rooij, Jeroen van MD

doi: 10.1097/ICO.0b013e318198399a
Clinical Science

Purpose: To investigate the long-term effect of oral acyclovir administered during the first 6 months after penetrating keratoplasty (PK) for herpetic eye disease (HED).

Methods: A 5-year follow-up was undertaken for a patient population from a placebo-controlled, randomized trial on acyclovir prophylaxis after keratoplasty. In this former study the effectiveness of oral acyclovir prophylaxis was significant during the first 2 years after keratoplasty. Prospective data such as graft survival, graft clarity, vascularization, infective events, and rejection episodes were obtained from the national keratoplasty follow-up registry. Additional clinical data were derived from the medical charts.

Results: For 47 of the original 63 enrolled patients, the 5-year follow-up was completed. Comparing the acyclovir group with the placebo group, we found that with regard to the cumulative clinically evident recurrences, there was a statistically significant lower monthly event rate in the acyclovir group (P = 0.037). There were no statistically significant differences in visual acuity or in the use of oral aciclovir between the two treatment groups. The incidences of graft failure, vascularization, and medication or surgery for glaucoma were too low to analyze differences between the two groups.

Conclusion: The results of our study suggest that oral acyclovir prescribed during the first 6 months after PK for HED protects against clinically evident HED recurrences during the first 5 years following PK.

From the *Rotterdam Eye Hospital, Rotterdam; †Westfriesgasthuis, Hoorn; ‡Academic Hospital of the Free University, Amsterdam; ¶Radboud University Nijmegen Medical Centre, Nijmegen; and ‖Erasmus University (Statistical Department), Rotterdam, The Netherlands.

Received for publication June 10, 2008; revision received November 20, 2008; accepted December 2, 2008.

Reprints: J. van Rooij, MD, The Rotterdam Eye Hospital, Schiedamse Vest 180, PO Box 70030, 3000 LM Rotterdam (e-mail:

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