Longterm prognosis for corneal grafting in herpes simplex keratitis

A previously reported cohort of patients was reviewed after mean follow-up of 10.9 years. The overall probability of survival was 45%, but first grafts had a greater probability of survival than second (P = 0.12) or further (P = 0.19) grafts. Preoperative active keratitis adversely affected survival (P = 0.123). The major cause of failure was graft rejection. Regrafts were more likely to fail from rejection episodes (P = 0.0005). Antiviral prophylaxis improved the outcome for rejection (P = 0.005) and reduced the incidence of HSK recurrence complicating rejection. Suppurative keratitis occurred in 12.4% of grafts as a complication of epitheliopathy including HSK recurrence. The outcome in these cases was particularly poor. Loose continuous graft sutures resulted in graft failure in 10.6% of grafts which may be improved by using interrupted suturing. Our results suggest the longterm prognosis for grafting in herpes simplex keratitis are not as good as may have been predicted from previous analyses.