{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:58:22Z","timestamp":1781661502052,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare the surgical outcomes of combined penetrating keratoplasty (PK) and cataract surgery with those of sequential surgery (cataract surgery after PK) for herpes simplex keratitis (HSK).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The medical records of consecutive patients diagnosed with HSK who underwent combined or sequential PK and cataract surgery in active and stable stages between June 2015 and June 2022 were reviewed retrospectively. Complications, graft survival, endothelial cell density (ECD), and final BCVA were compared and analyzed between both surgical methods in each stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 171 eyes of 171 patients were enrolled, including active stage (69 combined, 46 sequential) and stable stage (34 combined, 22 sequential). The average follow up was 24.2\u2009\u00b1\u200915.8\u2009months (range, 3\u2009months \u2013 48\u2009months). The final BCVA had obvious improvement and the postoperative ECD was not different in combined and sequential groups of each stage. In sequential group of active stage, 66.7% of persistent epithelial defects and 50% of HSK recurrence occurred within 3\u2009months after cataract surgery; nevertheless, compared to that in sequential group, capsular rupture (<jats:italic>p<\/jats:italic> =\u20090.021), persistent epithelial defects (<jats:italic>p<\/jats:italic> =\u20090.027), and HSK recurrence (<jats:italic>p<\/jats:italic> =\u20090.035) occurred more frequently in combined group, leading to a lower graft survival rate (<jats:italic>p<\/jats:italic> =\u20090.045); at the last visit, 46.4 and 67.4% of grafts remained clear in combined and sequential groups, respectively. By contrary, 82.4 and 50.0% of grafts remained clear in stable stages of combined and sequential groups at the last visit, respectively, and a higher graft survival rate was observed in combined group (<jats:italic>p<\/jats:italic> =\u20090.030).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although the postoperative ECD is not different between two surgical groups in each stage, sequential surgery in active stage of HSK seems to have advantages in less complications and higher graft survival rate, whereas combined surgery in stable stage has a better outcome than that in sequential surgery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1190485","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T13:42:18Z","timestamp":1689946938000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Combined versus sequential penetrating keratoplasty and cataract surgery for herpes simplex keratitis: a retrospective study"],"prefix":"10.3389","volume":"10","author":[{"given":"Yani","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nannan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanling","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixin","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"5514004","DOI":"10.1155\/2021\/5514004","article-title":"Indications and surgical techniques for repeat corneal transplantation in eastern China: a twelve-year study","volume":"2021","author":"Wan","year":"2021","journal-title":"J Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/ICU.0b013e32835aeec4","article-title":"Cataract surgery in patients with corneal disease","volume":"24","author":"Greene","year":"2013","journal-title":"Curr Opin Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/00003226-200005000-00015","article-title":"Corneal triple procedure: indications, complications, and outcomes: a developing country scenario","volume":"19","author":"Sridhar","year":"2000","journal-title":"Cornea"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1097\/00003226-200304000-00010","article-title":"Corneal opacity and cataract: triple procedure versus secondary approach","volume":"22","author":"Shimmura","year":"2003","journal-title":"Cornea"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1016\/j.jcrs.2011.03.039","article-title":"Corneal endothelial cell loss in post-penetrating keratoplasty patients after cataract surgery: phacoemulsification versus planned extracapsular cataract extraction","volume":"37","author":"Acar","year":"2011","journal-title":"J Cataract Refract Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1186\/s12886-020-01626-3","article-title":"Comparative analysis of the tear protein profile in herpes simplex virus type 1 epithelial keratitis","volume":"20","author":"Yang","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"750898","DOI":"10.3389\/fmed.2021.750898","article-title":"Trends in corneal transplantation and characteristics of donors in the Chongqing eye bank, China: a retrospective study, 1999-2018","volume":"8","author":"Tan","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.31729\/jnma.7906","article-title":"Stromal keratitis among herpes simplex keratitis patients in a tertiary eye hospital: a descriptive cross-sectional study","volume":"60","author":"Shrestha","year":"2022","journal-title":"JNMA J Nepal Med Assoc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1038\/s41433-020-01153-x","article-title":"Update on herpes simplex keratitis management","volume":"34","author":"Sibley","year":"2020","journal-title":"Eye (Lond)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3390\/jcm12010289","article-title":"Prevalence of herpesvirus DNA in corneal transplant recipients","volume":"12","author":"Bu","year":"2022","journal-title":"J Clin Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"48304","DOI":"10.1097\/j.jcrs.0000000000000745","article-title":"Cataract surgery in herpes simplex virus ocular disease","volume":"3","author":"Al-Ani","year":"2022","journal-title":"J Cataract Refract Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e7656","DOI":"10.1097\/MD.0000000000007656","article-title":"Evaluation of an interlaced triple procedure: penetrating keratoplasty, extracapsular cataract extraction, and non-open-sky intraocular lens implantation","volume":"96","author":"Yang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.4103\/0366-6999.189050","article-title":"Effects of cataract surgery on endothelium in transplanted corneal grafts: comparison of extracapsular cataract extraction and phacoemulsification for complicated cataract after penetrating keratoplasty","volume":"129","author":"Zhou","year":"2016","journal-title":"Chin Med J"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e922","DOI":"10.1111\/aos.14708","article-title":"Causes of corneal transplant failure: a multicentric study","volume":"99","author":"G\u00f3mez-Benlloch","year":"2021","journal-title":"Acta Ophthalmol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"772578","DOI":"10.3389\/fmed.2021.772578","article-title":"Ocular biometry of primary angle-closure disease in younger patients","volume":"8","author":"Lin","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1038\/eye.2008.301","article-title":"The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion","volume":"23","author":"Nguyen","year":"2009","journal-title":"Eye (Lond)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.antiviral.2017.09.013","article-title":"Recurrent herpetic keratitis despite antiviral prophylaxis: a virological and pharmacological study","volume":"146","author":"Rousseau","year":"2017","journal-title":"Antivir Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e16591","DOI":"10.1097\/MD.0000000000016591","article-title":"Epithelial keratitis mimicking herpes simplex keratitis in a patient after cataract surgery: a case report","volume":"98","author":"Zou","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.oftale.2022.02.003","article-title":"Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery","volume":"97","author":"Gessa-Sorroche","year":"2022","journal-title":"Arch Soc Esp Oftalmol (Engl Ed)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"150","DOI":"10.14712\/18059694.2020.57","article-title":"Corneal graft success rates in HSV keratitis: a systematic review","volume":"63","author":"Skarentzos","year":"2020","journal-title":"Acta Med (Hradec Kralove)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1055\/a-1306-0896","article-title":"Herpes simplex virus keratitis in a university tertiary referral Centre - clinical features and surgical approaches","volume":"238","author":"Alfaro Rangel","year":"2021","journal-title":"Klin Monatsbl Augenheilkd"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1097\/ICO.0000000000001592","article-title":"Epithelial keratitis after cataract surgery","volume":"37","author":"Cho","year":"2018","journal-title":"Cornea"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1007\/s10792-020-01539-6","article-title":"Ocular surgery after herpes simplex and herpes zoster keratitis","volume":"40","author":"Kanclerz","year":"2020","journal-title":"Int Ophthalmol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1097\/ICO.0000000000001819","article-title":"Association of iris damage with reduction in corneal endothelial cell density after penetrating keratoplasty","volume":"38","author":"Ibrahim","year":"2019","journal-title":"Cornea"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.1097\/ICO.0b013e3182a73822","article-title":"Immediate endothelial cell loss after penetrating keratoplasty","volume":"32","author":"Alqudah","year":"2013","journal-title":"Cornea"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.ophtha.2010.06.005","article-title":"Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial","volume":"118","author":"Cheng","year":"2011","journal-title":"Ophthalmology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1097\/00003226-200210000-00001","article-title":"Therapeutic penetrating keratoplasty: clinical outcome and evolution of endothelial cell density","volume":"21","author":"Claerhout","year":"2002","journal-title":"Cornea"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0266072","DOI":"10.1371\/journal.pone.0266072","article-title":"Analysis of risk factors of rapid attenuation of graft endothelium in the early stage after penetrating keratoplasty","volume":"17","author":"Xu","year":"2022","journal-title":"PLoS One"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/0002-9394(87)90410-7","article-title":"Assessment of success and complications of triple procedure surgery","volume":"104","author":"Meyer","year":"1987","journal-title":"Am J Ophthalmol"},{"key":"ref30","first-page":"627","article-title":"Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation. Specular microscopy ancillary study results","volume-title":"Ophthalmology","author":"Lass","year":"2008"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1190485\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T13:42:21Z","timestamp":1689946941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1190485\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,21]]},"references-count":30,"alternative-id":["10.3389\/fmed.2023.1190485"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1190485","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,21]]},"article-number":"1190485"}}