Surgical interventions in herpes simplex virus keratitis: Outcomes in a large cohort.

PURPOSE: Herpes simplex virus (HSV) keratitis is a significant cause of infectious corneal morbidity worldwide. Severe cases may require surgical intervention when medical therapy fails. This study evaluates surgical outcomes in managing advanced HSV keratitis.

METHODS

This was a retrospective observational cohort study conducted at a single tertiary care center. The objective was to assess the effectiveness of surgical interventions in stabilizing the ocular surface and improving visual acuity (VA) in patients with HSV keratitis. A retrospective analysis was performed on 377 patients who underwent surgical intervention for HSV keratitis between January 2020 and December 2023. Surgical indications included corneal perforations, persistent epithelial defects, neurotrophic keratitis, and visual rehabilitation. The primary outcomes were ocular surface stability and VA improvement.

RESULTS

Primary surgeries such as tissue adhesive with bandage contact lens, tarsorrhaphy, and penetrating keratoplasty achieved ocular surface stability in 74.3% of patients. A second surgical intervention was required in 57.02% of cases. VA improved significantly, with 8.22% achieving 6/18 or better at final follow-up.

CONCLUSION

Minimally invasive surgical techniques play a critical role in stabilizing the ocular surface in severe HSV keratitis. A stepwise, tailored surgical approach allows optimization of outcomes while deferring high-risk emergency keratoplasty.