Management of HSV-1 necrotizing keratitis with amniotic membrane transplantation combined with antiviral and steroid therapy

Purpose To report promoted healing of necrotizing herpetic keratitis after amniotic membrane transplantation (AMT) in conjunction with antiviral and corticosteroid therapy. Methods Herpes necrotizing stromal keratitis was defined as a corneal ulcer with a dense, whitish inflammatory infiltration and corneal scrapping positive for HSV-1 by polymerase chain reaction (PCR). Corneal smears and cultures were made to rule out bacterial and fungal infections. All patients received systemic antiviral treatment and topical antibiotics. When corneal ulcers were refractory to medical treatment, multilayered AMT was considered. During the post operative period, systemic antiviral treatment was continued and local corticosteroids were started. Main outcome measures were visual acuity and wound healing of corneal ulcers. Results Thirteen patients (13 eyes) with herpes necrotizing stromal keratitis were retrospectively reviewed. The mean follow up was 13.1 months (range 2-30 months). Amniotic membrane transplantation was performed in 9 cases (twice in one patient), within a mean of 17 days (range 2-43 days) after medical treatment initiation. Epithelial defects healed within a mean of 40 days (range 9-97 days) after AMT. At the last visit, mean visual acuity improved from 2.2 logMAR to 1.3 LogMAR (p=0.016). No serious side effects occurred during the follow up. Conclusion Multilayer AMT combined with antiviral and corticosteroid therapy seems to be effective in treating herpes necrotizing stromal keratitis. It provides restoration of ocular surface integrity and improvement of vision.