Successful Descemet Membrane Endothelial Keratoplasty in Proven Herpetic Endothelial Decompensation Requires Intensive Antiviral Therapy

Cornea. 2020 Feb;39(2):196-199. doi: 10.1097/ICO.0000000000002215.


Purpose: To report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with intensive antiviral therapy for corneal edema secondary to herpes simplex virus type 1 (HSV-1)-mediated endotheliitis.

Methods: All eyes with polymerase chain reaction positive for HSV-1 undergoing DMEK for endothelial decompensation between January 2014 and January 2018 were followed up prospectively at our tertiary referral center. All eyes had been free of active inflammation for a minimum of 9 months and were treated prophylactically with high-dose systemic and topical antivirals, which were continued for a prolonged period of time. Primary outcomes were the occurrence of immunological rejection and/or recurrence of endotheliitis, eventually resulting in graft failure. Secondary outcomes were best spectacle-corrected visual acuity and endothelial cell loss.

Results: Four consecutive eyes of 4 patients were included with a mean (±SD) patient age of 68.5 ± 15.1 years. The postoperative follow-up averaged 22 months. No eyes exhibited any signs of immunologic rejection, recurrence of endotheliitis, or graft failure. Mean (±SD) decimal best spectacle-corrected visual acuity improved from 0.2 ± 0.1 to 0.7 ± 0.2 (P = 0.007), whereas mean (±SD) endothelial cell loss was 56% ± 10.2% at the final postoperative follow-up.

Conclusions: DMEK is an effective option to treat corneal edema secondary to HSV-1-related endotheliitis. Intensive antiviral prophylaxis may reduce the risk of recurrence and subsequent graft failure.

MeSH terms

  • Acyclovir / therapeutic use*
  • Administration, Ophthalmic
  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / therapeutic use*
  • Combined Modality Therapy
  • Descemet Stripping Endothelial Keratoplasty*
  • Endothelium, Corneal / pathology*
  • Female
  • Ganciclovir / therapeutic use
  • Graft Survival / physiology
  • Herpesvirus 1, Human / drug effects
  • Humans
  • Keratitis, Herpetic / diagnosis
  • Keratitis, Herpetic / drug therapy
  • Keratitis, Herpetic / surgery
  • Keratitis, Herpetic / therapy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Slit Lamp Microscopy
  • Tomography, Optical Coherence
  • Visual Acuity / physiology


  • Antiviral Agents
  • Ganciclovir
  • Acyclovir