Süveges Ildikó, Füst Ágnes, Imre László
Semmelweis Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Budapest Mária u. 39. 1085.
Orv Hetil. 2013 Dec 29;154(52):2065-70. doi: 10.1556/OH.2013.29791.
Keratitis due to herpes simplex infection is a common cause of corneal damage resulting in impaired vision.
The aim of this study was to assess the outcome of penetrating keratoplasties in patients treated with systemic antiviral and immunosuppressive drugs.
The authors retrospectively analysed data of 12 patients who underwent penetrating keratoplasty. The average age at onset of the first keratitis preceding surgery was 18 years (between 5 and 40 years). The indication for surgery in 9 cases was to improve vision and in 3 patient to prevent corneal perforation. Nine patients were given both acyclovir and mycophenolate mofetil, as anti-viral agent and immunosuppressive treatment, respectively. Two patients were treated with anti-viral agent only while one patient received no systemic therapy. The average follow-up time was 53.1 months (between 16 and 84 months).
Of the 9 patients who underwent surgery for improving vision, 8 patients had transparent grafts during follow up without vascularization. All eight patients had been treated with acyclovir and mycophenolate mofetil. In one patient who had no systemic treatment recurrence and graft rejection was observed. Only one of the surgeries performed in acute stage of inflammation resulted in a properly healed transparent graft without recurrence and rejection. In this patient acyclivir and mycophenolate mofetil therapy had been given previously. In two cases the preventive - full or partial - systemic treatment had no effect. The visual acuity improved in all cases. In three patients visual acuity was influenced by some other factors as well.
The systemic acyclovir and mycophenolat mofetil therapy is fairly successful in perforating keratoplasty due to herpes simplex infection. Acyclovir decreases the risk of recurrence, while mycophenolate mofetil may prevent graft rejection. The timing of surgery is decisive; it leads to better results when performed in a scarred, noninflammatory state.
单纯疱疹感染所致角膜炎是导致视力受损的角膜损伤的常见原因。
本研究旨在评估接受全身抗病毒和免疫抑制药物治疗的患者穿透性角膜移植术的效果。
作者回顾性分析了12例行穿透性角膜移植术患者的数据。手术前首次发生角膜炎的平均发病年龄为18岁（5至40岁之间）。9例患者的手术指征是改善视力，3例患者是为了预防角膜穿孔。9例患者分别接受了阿昔洛韦和霉酚酸酯治疗，作为抗病毒药物和免疫抑制治疗。2例患者仅接受抗病毒药物治疗，1例患者未接受全身治疗。平均随访时间为53.1个月（16至84个月之间）。
在9例因改善视力而接受手术的患者中，8例在随访期间移植片透明且无血管化。所有8例患者均接受了阿昔洛韦和霉酚酸酯治疗。1例未接受全身治疗的患者出现复发和移植片排斥反应。仅1例在炎症急性期进行的手术获得了愈合良好的透明移植片，无复发和排斥反应。该患者此前接受过阿昔洛韦和霉酚酸酯治疗。2例预防性全身治疗（全部或部分）无效。所有病例的视力均有改善。3例患者的视力还受到其他一些因素的影响。
全身应用阿昔洛韦和霉酚酸酯治疗单纯疱疹感染所致穿透性角膜移植术相当成功。阿昔洛韦可降低复发风险，而霉酚酸酯可预防移植片排斥反应。手术时机至关重要；在瘢痕化、非炎症状态下进行手术可取得更好的效果。
