Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China.
Graefes Arch Clin Exp Ophthalmol. 2012 Aug;250(8):1187-94. doi: 10.1007/s00417-012-1947-2. Epub 2012 Feb 17.
To evaluate the therapeutic effect of deep anterior lamellar keratoplasty (DALK) in patients with herpetic stromal keratitis (HSK).
Forty-three eyes belonging to 42 patients with HSK, including 22 eyes in the active phase and 21 eyes in the quiescent phase, underwent DALK at the Shandong Eye Institute from January 2006 to December 2009. All patients with active disease had received intravenous acyclovir and amniotic membrane implants prior to DALK. Herpes simplex virus type 1 (HSV-1) antigens from excised corneal buttons were detected by immunohistochemistry.
The follow-up ranged from 1 to 4 years (mean, 29.1 months). Graft rejection occurred in one eye (2.3%) and was reversed. Among the other 42 survived grafts (97.7%), 37 remained clear at the last visit. The best spectacle-corrected visual acuity was 20/200 or better in 95.2% of eyes and 20/40 or better in 38.1% of eyes. Six eyes (14.0%) developed recurrent HSK, one of which received a second keratoplasty due to ineffective antiviral medication. There were no significant differences in endothelial cell density between 6 months and 12 months after the surgery. By immunohistochemistry, HSV-1 antigens were observed in the stroma of 18 of 32 corneal buttons.
DALK can not only remove the corneal lesions of HSK but also reduce latent or persistent viral loads in the cornea. In eyes with active or quiescent HSK but otherwise healthy endothelia, DALK seems to be safe and promising for its favorable visual outcome, graft survival rate, and low endothelial cell loss.
评估深板层角膜移植术（DALK）治疗疱疹性基质角膜炎（HSK）的疗效。
2006 年 1 月至 2009 年 12 月，山东眼科研究所对 42 例（43 只眼）HSK 患者行 DALK，其中活动期 22 只眼，静止期 21 只眼。所有活动期患者在 DALK 前均接受静脉注射阿昔洛韦和羊膜植入。应用免疫组织化学法检测切除角膜瓣中的单纯疱疹病毒 1 型（HSV-1）抗原。
随访 1~4 年（平均 29.1 个月）。1 只眼（2.3%）发生排斥反应，经治疗后逆转。在其余 42 只存活的移植物中，37 只在末次随访时保持透明。最佳矫正视力 20/200 或以上者占 95.2%，20/40 或以上者占 38.1%。6 只眼（14.0%）发生复发性 HSK，其中 1 只眼因抗病毒药物治疗无效而接受第二次角膜移植。术后 6 个月和 12 个月时，内皮细胞密度无显著差异。免疫组织化学法显示，32 只角膜瓣中有 18 只角膜基质存在 HSV-1 抗原。
DALK 不仅能去除 HSK 的角膜病变，还能降低角膜内潜伏或持续的病毒载量。对于有活动期或静止期 HSK 但其他方面健康的内皮细胞，DALK 似乎是安全且有前途的，因为其具有良好的视力预后、移植物存活率和低内皮细胞丢失率。
