Penetrating keratoplasty for herpetic keratitis: decision-making and management

The outlook for keratoplasty in herpetic keratitis has improved significantly over the past decade. While only two out of three grafts in vascularized and regrafted eyes and in eyes with active disease are clear after two years, in quiet eyes with no significant vascularization, the success rate exceeds 80 percent. The significant factor in the improved results, in both favorable and unfavorable cases, is the improvement in surgical technique, involving the operating microscope, the 10-0 nylon suture, and the increased understanding of the pathophysiology of corneal grafting, which has resulted in more sophisticated postoperative care. In our experience, the routine use of high levels of topical steroids in the immediate postoperative period, followed by a rapid tapering of these medications, has been particularly successful.