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Prospective Randomized Trial with Systemic Aacyclovir and Mycophenolate Mofetil (MMF) following Penetrating Keratoplasty in Patients with Herpetic Eye Disease
1Mayer K., 1Reinhard T., 1Reis A., 2Voiculescu A., 1Sundmacher R.,
1Heinrich-Heine-Universität Düsseldorf, Universitäts-Augenklinik (Düsseldorf)
2Heinrich-Heine Universität Düsseldorf, Klinik für Nephrologie und Rheumatologie (Düsseldorf)
Purpose: Main reasons for graft failure following penetrating keratoplasty in patients with herpetic eye disease are recurrence of the underlying disease and allograft rejection. In a randomised trial the effect of systemic acyclovir and MMF on these post-keratoplasty complications was evaluated.
Method: In a prospective randomised trial 30 patients were treated in three groups. In group A patients received acyclovir 5x200 mg/day for three weeks. In group B patients were treated with acyclovir 5x200 mg/day for one year and patients in group C received acyclovir 5x200 mg/day for one year in combination with MMF 1g twice daily for one year.
Results: In group A two patients had five herpes recurrences. One patient had a moderate and one further patient had a severe allograft rejection. In group B two patients developed severe allograft rejections. Herpes recurrences were not observed under acyclovir prophylaxis but once after cessation of the prophylaxis. In group C no herpes recurrence was observed but two slight allograft rejections in one patient. One further patient developed a moderate allograft rejection after cessation of MMF.
Conclusions: These results demonstrate that systemic acyclovir protects the graft from recurrences of herpetic disease as long as it is administered. Simultaneously administered mycophenolate mofetil does not trigger herpes recurrences and protects the graft from severe allograft rejections. The combination of systemic acyclovir and mycophenolate mofetil can be recommended therefore, for patients with high risk of herpes recurrence and allograft rejection.