98th Annual Meeting DOG 2000

K 111

Highly active antiviral and immunosuppressive therapy following keratoplasty in patients with herpetic eye disease

A. Reis, T. Reinhard, R. Sundmacher

Introduction: HSV infection is the most common cause of corneal blindness in developed countries. Perforating keratoplasty is the only therapeutic option for visual rehabilitation in patients with severely scarred corneas. Recurrence of the underlying disease and allograft rejection (AR) are the most common causes of graft loss. Systemic immunosuppression with Cyclosporin A is contraindicated due to the danger of HSV recurrence.

The potent immunosuppressive properties of mycophenolate mofetil (MMF) has been shown in several clinical studies. By reducing the intracellular guanosid-pool MMF inhibits the proliferation of lymphocytes. As these guanosin-nukleosides also act as competing-substrates to the acyclovir-antimetabolites at the viral DNA-polymerase, a synergistic effect of MMF and acyclovir might be expected. This effect has already been shown experimentally. The aim of this study was to evaluate the efficiency and safety of a double-drug regimen with MMF and acyclovir in the prevention of acute allograft rejection and HSV recurrence following corneal transplantation.

Methods: Patients following keratoplasty due to herpetic eye disease have been treated with MMF 1 g twice daily and acyclovir 5 x 200 mg/day. Primary efficiency variables have been the number of acute AR and recurrence of herpetic disease per patient and time. The number of adverse events have been documented for safety analysis.

Results: Fourteen patients have been enrolled. The average follow up period was 8.2 (┬▒1.3) months. No graft opacifications have been seen. We have seen one AR and one recurrence of herpetic disease. With an overall 14.3% of treatment failures, this protocol was statistically significantly superior when compared to our historical control group (acyclovir 5 x 200 mg/day for three weeks postoperatively, 32.0%).

Conclusions: In this first study on the efficacy and safety of a double drug regimen with acyclovir and MMF for the control of acute corneal AR and HSV-recurrence following keratoplasty in patients with herpetic eye disease, the combination therapy has been shown to be an highly efficient and safe protocol for graft protection.

Eye clinic, Heinrich Heine University, D├╝sseldorf