Mayer Klaus, Reinhard Thomas, Reis Alexander, Voiculescu Adina, Sundmacher Rainer
Eye Hospital, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Graefes Arch Clin Exp Ophthalmol. 2003 Dec;241(12):1051-4. doi: 10.1007/s00417-003-0724-7. Epub 2003 Aug 20.
The main reasons for graft failure following penetrating keratoplasty in patients with herpetic eye disease are recurrence of herpetic disease and allograft rejection. In a randomised trial the effect of systemic acyclovir and mycophenolate mofetil (MMF) on these post-keratoplasty complications was evaluated.
Patients with typical clinical findings of recurrent herpetic keratitis were enrolled in this single-centre study after contraindications to systemic immunosuppression were ruled out. In a prospective randomised trial 30 patients were treated in three groups. In group A patients received acyclovir 200 mg five times/day for 3 weeks. In group B patients were treated with acyclovir 200 mg five times/day for 1 year, and patients in group C received acyclovir 200 mg five times/day in combination with MMF 1 g twice daily for 1 year.
In group A 3 patients experienced seven herpes recurrences. One patient had a moderate and one further patient a severe allograft rejection. In group B three severe allograft rejections were observed. Herpes recurrences did not occur while receiving acyclovir prophylaxis, but only once after the prophylaxis had been stopped. In group C no herpes recurrence was observed, and only two mild allograft rejections occurred while being under combined acyclovir-MMF therapy. Another mild and one moderate allograft rejection were observed after cessation of MMF.
These results demonstrate that systemic acyclovir protects the grafts from recurrences of herpetic disease as long as it is administered at efficient doses. Simultaneously administered mycophenolate mofetil does not trigger herpes recurrences and protects the graft from severe allograft rejections, but mild, less dangerous immune reactions may still occur while receiving MMF. The combination of systemic acyclovir and mycophenolate mofetil therefore is recommended for patients at high risk for herpes recurrence and allograft rejections.
疱疹性眼病患者穿透性角膜移植术后移植失败的主要原因是疱疹疾病复发和同种异体移植排斥反应。在一项随机试验中，评估了全身应用阿昔洛韦和霉酚酸酯（MMF）对这些角膜移植术后并发症的影响。
排除全身免疫抑制的禁忌证后，将具有复发性疱疹性角膜炎典型临床表现的患者纳入这项单中心研究。在一项前瞻性随机试验中，30例患者被分为三组进行治疗。A组患者接受阿昔洛韦200mg，每日5次，共3周。B组患者接受阿昔洛韦200mg，每日5次，共1年，C组患者接受阿昔洛韦200mg，每日5次，联合霉酚酸酯1g，每日2次，共1年。
A组3例患者出现7次疱疹复发。1例患者发生中度排斥反应，另1例患者发生重度同种异体移植排斥反应。B组观察到3例重度同种异体移植排斥反应。接受阿昔洛韦预防治疗期间未发生疱疹复发，但预防治疗停止后仅发生1次。C组未观察到疱疹复发，在阿昔洛韦 - MMF联合治疗期间仅发生2例轻度同种异体移植排斥反应。停用MMF后观察到1例轻度和1例中度同种异体移植排斥反应。
这些结果表明，只要给予有效剂量的全身阿昔洛韦，就能保护移植眼免受疱疹疾病复发的影响。同时给予霉酚酸酯不会引发疱疹复发，并能保护移植眼免受严重的同种异体移植排斥反应，但在接受MMF治疗期间仍可能发生轻度、危险性较小的免疫反应。因此，对于疱疹复发和同种异体移植排斥反应高危患者，推荐全身应用阿昔洛韦和霉酚酸酯联合治疗。
