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Deep Anterior Lamellar Deep Anterior Lamellar Keratoplasty in Herpes Keratoplasty in Herpes
Simplex Corneal OpacitiesSimplex Corneal Opacities
V. SarnicolaV. Sarnicola
ItalyItaly
ASCRS-ASOA ANNUAL MEETINGASCRS-ASOA ANNUAL MEETINGBoston April 9-14, 2010Boston April 9-14, 2010
Financial DisclosureFinancial Disclosure
Author have no financial interest or relationships to Author have no financial interest or relationships to disclose disclose
PurposePurpose
● To report our experience with deep anterior
lamellar keratoplasty (DALK) for the
treatment of corneal opacities following
herpetic keratitis.
Materials and MethodsMaterials and Methods
• Cases report study
• 52 eyes with post-herpetic stromal scars of
52 patients (2002 - 2006)
• Average follow-up : 31 months
• Mean age: 46,5 yrs (range 35-60 yrs)
Materials and MethodsMaterials and Methods
• Descemet membrane reachedDescemet membrane reached
• Intra and postoperative complications Intra and postoperative complications
• Pre and postop. visual acuityPre and postop. visual acuity
• Endothelial cell densityEndothelial cell density
• Therapeutic protocolTherapeutic protocol
• Recurrence of HSV keratitis/rejectionRecurrence of HSV keratitis/rejection
Antiviral prophylaxis Antiviral prophylaxis
• Acyclovir 800 mg/dayAcyclovir 800 mg/day
• Corticosteroids drops once a dayCorticosteroids drops once a day
• Patients without episodes of recurrence Patients without episodes of recurrence
for 1 year for 1 year
52 DALK after HSV- 2002/200652 DALK after HSV- 2002/2006
NoNo
NoNo
NoNo
2/522/52
(4%)(4%)
7/527/52
(13,5%)(13,5%)
45/5245/52
(86,5%)(86,5%)
Conversion to PKPConversion to PKP
Double chamberDouble chamber
MacroperfMacroperf
MicroperfMicroperf
PredescemeticPredescemetic
DescemeticDescemetic
ResultsResults
Descemet membrane Descemet membrane ExposureExposure
Descemet membrane Descemet membrane ExposureExposure
DESCEMETIC DESCEMETIC (dDALK 86,5 %)(dDALK 86,5 %)
PRE-DESCEMETICPRE-DESCEMETIC
(pdDALK 13,5%)(pdDALK 13,5%)
Visual acuity
0020/10020/100
0020/8020/80
1 (2%)1 (2%)20/7020/70
2 (4%)2 (4%)20/6020/60
2 (4%)2 (4%)20/5020/50
5 (10%)5 (10%)20/4020/40
9 (17%)9 (17%)20/3020/30
6 (11%)6 (11%)20/2520/25
27 (27 (52%52% ) )20/2020/20
Number/% of Number/% of patients patients
BCVABCVA
Endothelial Cell Count 25/52 Endothelial Cell Count 25/52
Average of endothelial cell countAverage of endothelial cell countAverage of endothelial cell countAverage of endothelial cell count
2272 cel/mm22272 cel/mm22375 cel/mm22375 cel/mm2Endothelial Cell Endothelial Cell DensityDensity
12 months12 months6 months6 monthsFollow-upFollow-up
CONCLUSIONSCONCLUSIONS
• Therapy goals:Therapy goals:
• Virus proliferation control/erradicationVirus proliferation control/erradication
• Systemic antiviralSystemic antiviral
• Immune response modulationImmune response modulation
• Local and general steroidsLocal and general steroids