Four years' experience with triple procedures in herpes-afflicted eyes

Keratoplasties are performed relatively frequently in herpes-afflicted eyes. However, intraocular lenses (IOLs), for eyes with intraocular recurrent herpes simplex virus (HSV) disease remain a verdict in most surgical centers. As most herpetic disease is uniocular and cataract is a frequent complication in the long run, a real need exists for triple procedures in such eyes so as to achieve their full visual rehabilitation. Taking full advantage of systemic aciclovir therapy and prophylaxis, we started with triple procedures in herpes-afflicted eyes in 1987. Up to July 1991, we operated on 29 eyes, and 28 could be optically rehabilitated. One eye was given up and received a conjunctival cover for sociomedical reasons. Three repeat keratoplasties (10%) were necessary, and a considerable number of complications had to be overcome; ten eyes suffered from sustained fibrinous exsudations (35%), ten were threatened by one or more endothelial immune therapy reactions (35%), and ten experienced one or more herpes recurrences (35%), mostly intraocular recurrences. As this study was not performed as a randomized, placebo-controlled, double-blind study, no absolute scientific proof of aciclovir's value in these patients can be presented. Nonetheless, we would conclude from the exceedingly good rehabilitation rate of 96% observed during an average follow-up period of 19 months that in all probability, systemic aciclovir was in the first rank responsible for this success rate. Thus, there is good clinical evidence that systemic aciclovir prophylaxis and therapy is indeed the most important key for successful triple procedures in eyes afflicted with herpetic disease.