Hello Mr.Ababneh,

I recocomend you to perform anivascular treatment using Avastin or Lucentis (subconjuncival 0,1 ml 2-3 times with interruption 1 month). In parallel use NSAI instillations (BID or TID). In a one half of the year, produce a lamellar or penetrating keratoplasty.

A prophylactic dose of oral Acyclovir (400 mg bd) to be continued for the life of the graft would be my recommendation for improving survival rates after keratoplasty.

Also, a relatively slow taper of topical steroid over a year or so, with a minimal dose of one or twice daily application to be continued indefinitely in case of no other contraindication is desirable.

Here are links to some literature showing decreased rates of recurrence of herpetic keratitis, graft rejection and graft failure after keratoplasty with the use of oral Acyclovir - 

http://journals.lww.com/corneajrnl/Abstract/1994/05000/A_Prospective_Randomized_Trial_of_Oral_Acyclovir.7.aspx

http://archopht.jamanetwork.com/article.aspx?articleid=411740

http://www.aaojournal.org/article/S0161-6420(03)00798-X/abstract

http://journals.lww.com/corneajrnl/pages/articleviewer.aspx?year=2007&issue=09000&article=00006&type=abstract

Regards,

Jayesh Vazirani

In addition, wait for at least 6 months after the last recurrence to do a PK. If there have been more than one failed grafts with vascularisation, I prefer to do a Boston Keratoprosthesis in these patients. Results are excellent with over 90% retianing useful vision indefinitely.