Clinical Manifestations and Outcomes of HSK Following Corneal Transplantation

Dan Wu¹Hui Huang¹Min Zheng¹Qi Chen¹Zhou Zhou¹Li Jiang¹Yuanhua Li¹Yiyun Liu²Baikai Ma²Guoqing Chen¹Yujun Huang¹Fengping Cen¹Binghua Chen¹Fengmei Li¹Hong Qi^1*Fan Xu^1*Qianqian Lan^1*

• ¹Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
• ²Peking University Third Hospital Ophthalmology Department, Beijing, China

Purpose: To investigate the clinical manifestations and outcomes of herpes simplex keratitis (HSK) infection following corneal transplantation. Methods: This retrospective study analyzed medical records of patients who underwent corneal transplantation at the People's Hospital of Guangxi Zhuang Autonomous Region between January 2018 and March 2024, with a minimum follow-up period of one year. The study examined post-transplantation HSV infections, including the timing of herpes simplex virus (HSV) infection, HSK classification, clinical manifestations, and outcomes.Results: A total of 411 patients (411 eyes) were followed up. Among them, 88 cases (21.41% of 411 cases) were diagnosed with or suspected of HSK before corneal transplantation. Of these 88 cases, 13 cases (14.77% of 88 cases) developed recurrent HSK after surgery (8 cases underwent corneal transplantation during the acute phase, and 5 cases during the scarring phase). There were 323 cases with no evidence of HSK before corneal transplantation, among which 27 cases (8.36% of 323 cases) developed new-onset HSK after corneal transplantation. Among all 411 patients, a total of 40 cases (9.73% of 411 cases) developed HSK after corneal transplantation. Regarding HSK types: epithelial HSK occurred in 11 cases (27.5% of 40 cases), all of which achieved corneal transparency. Stromal necrotizing HSK occurred in 8 cases (20% of 40 cases), with 2 cases developing corneal nebula, 5 cases developing corneal macula, and 1 case requiring repeat corneal transplantation due to near-perforation. Combined epithelial, stromal, and endothelial HSK occurred in 17 cases (42.5% of 40 cases), with 1 case developing corneal nebula, 4 cases developing corneal macula, 10 cases developing corneal leucoma, and 2 cases requiring repeat corneal transplantation due to corneal perforation. Endothelial HSK occurred in 4 cases (10% of 40 cases), with 2 cases achieving grade 0 corneal transparency and 2 cases achieving grade 2 corneal transparency.Regular follow-up is essential for all patients post-surgery. For those with a history of HSK, vigilance for HSK is critical, while timely diagnosis and differentiation of HSK are crucial for non-HSK patients.When administering systemic antiviral therapy, it is important to adjust the frequency and intensity of steroid treatments promptly to prevent irreversible graft opacity.