1. Deep Anterior Lamellar Keratoplasty in Herpes Simplex Corneal Opacities V. Sarnicola Italy ASCRS-ASOA ANNUAL MEETING Boston April 9-14, 2010

2. Financial Disclosure Author have no financial interest or relationships to disclose

3. Purpose ● To report our experience with deep anterior lamellar keratoplasty (DALK) for the treatment of corneal opacities following herpetic keratitis.

4. Materials and Methods Cases report study 52 eyes with post-herpetic stromal scars of 52 patients (2002 - 2006) Average follow-up : 31 months Mean age: 46,5 yrs (range 35-60 yrs)

5. Materials and Methods Descemet membrane reachedDescemet membrane reached Intra and postoperative complicationsIntra and postoperative complications Pre and postop. visual acuityPre and postop. visual acuity Endothelial cell densityEndothelial cell density Therapeutic protocolTherapeutic protocol Recurrence of HSV keratitis/rejectionRecurrence of HSV keratitis/rejection

6. Antiviral prophylaxis Acyclovir 800 mg/dayAcyclovir 800 mg/day Corticosteroids drops once a dayCorticosteroids drops once a day Patients without episodes of recurrence for 1 yearPatients without episodes of recurrence for 1 year

7. 52 DALK after HSV- 2002/2006 No No No 2/52(4%) 7/52(13,5%)45/52(86,5%) Conversion to PKP Double chamber Macroperf Microperf PredescemeticDescemeticResults

8. Descemet membrane Exposure DESCEMETIC (dDALK 86,5 %) PRE-DESCEMETIC (pdDALK 13,5%)

9. Visual acuity020/100 020/80 1 (2%) 20/70 2 (4%) 20/60 20/50 5 (10%) 20/40 9 (17%) 20/30 6 (11%) 20/25 27 (52% ) 20/20 Number/% of patients BCVA

10. Endothelial Cell Count 25/52 Average of endothelial cell count 2272 cel/mm2 2375 cel/mm2 Endothelial Cell Density 12 months 6 months Follow-up

11. CONCLUSIONS Therapy goals:Therapy goals: Virus proliferation control/erradicationVirus proliferation control/erradication Systemic antiviralSystemic antiviral Immune response modulationImmune response modulation Local and general steroidsLocal and general steroids

12. DALK in post Herpetic corneal scars Preop Postop