Researchers in Paris have shown that Descemet’s membrane endothelial keratoplasty (DMEK) for eyes compromised by herpes simplex keratitis, but with limited corneal scarring and fibrosis, showed good but limited visual recovery compared with DMEK performed for other etiologies. The study advises practitioners to monitor patients carefully and prescribe a preventive high-dose regimen of oral antivirals, especially during the first months after surgery.

The retrospective interventional case series included 17 eyes that received DMEK for endothelial decompensation secondary to herpes simplex. Researchers then compared the visual outcomes and complications with those of 72 consecutive eyes that received DMEK for Fuchs’ endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) during the same period.

Corrected-distance visual acuity (CDVA) improved from 1.16 ± 0.46logMAR to 0.62 ± 0.44logMAR, and corneal pachymetry significantly decreased from 695μm ± 53μm at day one to 569μm ± 88μm at two months. However, postoperative complications occurred in 12 eyes, including primary graft failure (12%), endotheliitis (29%), corneal ulcers (35%) and cystoid macular edema (18%). The study noted that most complications occurred shortly after surgery, with a median delay of 2.5 months. The complication rates for DMEK in FECD and PBK were significantly lower.

Researchers proposed that lower visibility during surgery, worse corneal edema, a resurgence of infection/inflammation after surgery and the decrease in corneal sensitivity in herpes simplex eye disease all might have been responsible for the increased rate of complications. Nevertheless, they suggested physicians closely monitor patients and maintain a high dose of valacyclovir to lower the risk of a relapsing herpetic infection and graft failure.

Abdelmassih Y, Dubrulle P, Sitbon C, et al. Therapeutic challenges and prognosis of Descemt’s membrane endothelial keratoplasty in Herpes simplex eye disease. Cornea. February 29, 2019. [Epub ahead of print].