Photodynamic Therapy for the Management of Lipid Keratopathy Secondary to Herpetic Keratitis.

PURPOSE: To report the quantitative effectiveness of photodynamic therapy (PDT) with verteporfin in reducing corneal neovascularization (CNV) and lipid keratopathy (LK) in patients with herpetic interstitial keratitis.

METHODS

We retrospectively evaluated patients with secondary LK due to herpetic keratitis who underwent PDT with Verteporfin. We analyzed before and after PDT, visual acuity (VA) and the percentage of CNV, LK, and total pathological corneal areas. The number of stromal neo-vessels and its activity, and the severity of the corneal opacity were also analyzed.

RESULTS

We studied nine consecutive patients. The CNV area, LK extent, pathological area, vessel count, vessel activity and corneal opacity all exhibited a statistically significant decrease (p < 0.05) in all patients following PDT. A second PDT was required in 3 patients. Complete vascular occlusion was observed in 5 eyes (55.5%), and partial occlusion in 3 eyes (33.5%). The mean post-treatment VA was 0.76 ± 0.32. VA improved by more than 1 line in 5 eyes (55.5%), with more than 2 line-improvement observed in 4 eyes (44.4%). It remain unchanged in 3 eyes (33.3%), while one patient (11%) worsened. No adverse effects were detected after a mean of 14.9 ± 3.9 years follow-up. There was no relapse of herpetic keratitis after discharging 88,8% patients (follow-up after discharged 8.1 ± 4.6 years).

CONCLUSION

PDT with verteporfin is a safe and effective treatment of herpetic CNV and LK, with long lasting efficacy. Additionally, after the treatment, our cases had a lower incidence of herpetic recurrences than expected.