ABSTRACT
AIM: To evaluate the outcome of corneal grafting in patients with stromal keratitis of herpetic (HSK) and non-herpetic origin, using predefined diagnostic criteria and standardised postoperative therapeutic strategies. METHODS: 384 adult immunocompetent recipients of a corneal graft for herpetic (n = 186) or non-herpetic (n = 198) keratitis were followed up prospectively for up to 5 years. RESULTS: The herpetic group displayed significantly more corneal vascularisation (p = 0.013), more epithelial defects (p = 0.049), lower corneal sensitivity (p <0.001), more graft rejection episodes (p = 0.002), and required larger grafts (p<0.001). However, the postoperative course of visual acuity, endothelial cell numerical density, and rate of graft failures were similar in both groups. After 5 years, cumulative probability of graft survival in HSK patients (40.85%) was similar to that observed in individuals with non-herpetic keratitis (50.15%; log rank = 0.874; relative risk: 1.04). CONCLUSION: Despite a markedly higher preoperative risk profile in herpetic eyes, the functional outcomes of grafts in individuals with keratitis of herpetic or non-herpetic origin were similar. Probably the most important contribution is a consequent close follow up and a therapeutic strategy including systemic prophylaxis of viral recurrence and of graft rejection by well adopted local steroid therapy.
Subject(s)
Corneal Transplantation , Keratitis, Herpetic/surgery , Adult , Aged , Antiviral Agents/therapeutic use , Combined Modality Therapy , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Humans , Keratitis/surgery , Keratitis, Herpetic/diagnosis , Male , Middle Aged , Postoperative Care/methods , Prognosis , Prospective Studies , Recurrence , Risk Factors , Treatment Outcome , Visual AcuityABSTRACT
The most common and distressing symptoms following anesthesia and surgery are pain and emetic problems. Under most circumstances, pain causes the greater amount of suffering, particularly after major surgery, but in some instances postoperative nausea and vomiting (PONV) may be more distressing, particularly after minor surgery. In outpatient surgery, emesis may also have important economic implications, for example, admission to hospital beds because of intractable vomiting. Antimetic drugs given during the perioperative period may be associated with unwanted side effects, including sedation, hypotension and extrapyramidal reactions. Since 1986 there have been studies reporting beneficial antiemetic effects for Pe 6 stimulation on the right or both forearms in adults using either needling (acupuncture) or pressure (acupressure). The majority of these studies have investigated postoperative nausea and vomiting. But Pe 6 stimulation has also been shown to be an effective antiemetic for symptoms associated with pregnancy and chemotherapy. Although Pe 6 electro-acupuncture and acupressure are recognized as having an antiemetic effect, its inconvenient instrumentation may limit its clinical applicability. There have also been studies reporting beneficial antiemetic effects of P 6 acupoint injection with 50% glucose and acupuncture of the ear.
