1. Long term Follow-up of PK cases with herpetic Leukomas, treated with topical Acyclovir and steroids WORLD CORNEA CONGRESS VII 2015 Ramon Naranjo-Tackman,MD Mexico City

2. Rationale and Purpose Herpetic scars and resilient ulcers are a common indication for penetrating or deep anterior lamellar grafts. The conventional Treatment try to cover against potential herpetic recidivant activity that can extend to the graft. Oral Acyclovir is the treatment of choice, besides the topical treatment, based on steroids, antibiotics and lubricants. Little is known about the efficacy of topical antiviral to prevent viral recidivant lessions in the graft. Purpose: To establish the long term visual results in PK cases, indicated for Herpetic leukomas, treated postoperatively with topical acyclovir

3. Material and methods A retrospective review of PK cases intervened from January 1998 and December 2002, was done, searching for cases where PK indication was a Postherpetic Leukoma. Time to PK, number of herpetic attacks, therapeutic regime, UAVA and BCVA pre and post op, as well as final corneal transparency, were analyzed.

4. Therapeutic regime In Herpetic leukomas, a.25 larger donnor was cut, and sutured using 16 nylon 10.0 single sutures. If The Herpetic lession was active: Ulcer or perforation a 0.50 mm larger donnor was used, and sutured using 16 single nylon 10-0 sutures. In both cases: The first 3 months Acyclovir ophthalmic ointment and topical steroids was administered QID, plus lubricant drops. After three Mo. Both were tapered to TID until Mo. 12. When a reduction to once a day was mantained until Mo. 18.

5. Results The charts of 38 eyes from 38 patients, were reviewed. In all cases topical Acyclovir ophthalmic ointment, plus topical steroids and lubricants were indicated. Mean time from first herpetic episode to PK: 175.2±70.8 Mo. Number of herpetic episodes: 2.68±0.94. Follow-up was 57.7Mo. ±30.9. Time from PK to Last Exam: 0.72±0.56 Mo. BCVA PreOp: 1.30±0.56. 65.7% of grafts, remained clear. 12.63% of cases had an herpetic recurrence, 21.62% had an opacque graft, in 1 case a new graft was indicated. 2 cases had glaucoma.

6. Conclusions This series shows, that topical acyclovir ointment, doesn't have more complications, compared with results that have been published with other post PK therapeutic schemes, limiting the area to be treated to the eye, and not the systemic scenario. Van Rooij J et al, Showed in a 68 graft cases series, that oral acyclovir prevented recurrences in all but 2 eyes, while the placebo group had 9 recurrences ( Effect of oral acyclovir after penetrating keratoplasty for herpetic keratitis: A placebo controled multiventer trial. Ophthalmology.2003;110:1916-9 ) In another series, Akova YA et al, demonstrated efficacy using oral acyclovir, but reported 1 recidivant lession in the Corneal leukoma group and 2 recurrences in the Perforated group ( Efficacy of low-dose and long-term oral acyclovir therapy after penetrating keratoplasty for herpes simplex Keratitis. Ocul Immunol Inflamm. 1999;7:51-60. ) It is evident that a comparison has to be done against the use of only oral acyclovir or a combined scheme