Cryosurgery and immunotherapy in herpes keratitis.

As early as 1930 herpes simplex keratitis was considered to be the most important specific keratitis in the United States (Gundersen, I936; Thygeson, 1953). This statement is true today, not only for the United States but for all other countries outside the tropical and subtropical zones having a high standard of hygiene and medical care. With the advent of local steroid medication in the treatment of eye disease, herpes keratitis seems to have become more severe and the once rare bilateral cases are no longer uncommon (Howard and Kaufman, I962). Andrews and Carmichael (I 930) found antibodies to Herpes simplex in the sera of a large number of normal adults, and noticed that recurrent herpes, that is herpes labialis and herpes of the eye, did not occur in subjects without such antibodies. In other words, patients with herpes keratitis have circulating antibodies and a significant titre of neutralizing and complement-fixation antibodies can be found in their serum. Krwawicz (i965) introduced the use of low temperature application to the cornea in cases of herpes keratitis and reported good results. This work was duplicated by the present authors who found inconsistent and poor results in cases of recurrent and deep stromal herpes. For this reason a new method was evolved which is based upon the use of corneal cryosurgery combined with topical application of human immune serum.