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Effect of Prophylactic Oral Acyclovir After Penetrating Keratoplasty for Herpes Simplex Keratitis

Garcia, Denise D MD; Farjo, Qais MD; Musch, David C PhD; Sugar, Alan MD

doi: 10.1097/ICO.0b013e3180e79b77
Clinical Science

Purpose: To determine the effect of routine use of prophylactic oral acyclovir after penetrating keratoplasty (PK) for herpes simplex virus (HSV) keratitis on recurrence, rejection, and graft failure rates.

Methods: Records from 70 consecutive patients who underwent PK for HSV keratitis at the W.K. Kellogg Eye Center between August 1, 1990, and December 31, 2000, were reviewed. Data collected included preoperative disease activity, duration, host vascularity, pre- and postoperative vision, and antiviral use. Particular attention was given to all episodes of HSV recurrence, graft rejection, and failure.

Results: Fifty-six patients (80%) were treated with prophylactic oral acyclovir after surgery. This cohort experienced fewer episodes of rejection (P = 0.006) and better overall graft survival (P = 0.04) than those who were not treated with prophylactic oral antivirals. There was no statistically significant difference in recurrence-free survival between the 2 groups (P = 0.22). Cox regression analysis failed to identify any single variable as a statistically significant predictor of recurrence, rejection, or graft failure.

Conclusions: Prophylactic oral acyclovir use after PK for HSV keratitis is associated with decreased episodes of rejection and improved graft survival.

From the *Henry Ford Health System, Livonia, MI; the †Vision Associates, Toledo, OH; and the ‡Kellogg Eye Center, University of Michigan, Ann Arbor, MI.

Received for publication March 23, 2007; revision received May 4, 2007; accepted May 8, 2007.

Supported in part by a departmental grant from Research to Prevent Blindness, New York, NY.

Reprints: Alan Sugar, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105 (e-mail:

Copyright © 2007 Wolters Kluwer Health, Inc. All rights reserved.