Delayed herpes zoster pseudodendrites. Polymerase chain reaction detection of viral DNA and a role for antiviral therapy.
BACKGROUND
The late-onset pseudodendrites, delayed corneal mucous plaques, of herpes zoster ophthalmicus are reported to be of mechanical or immune origin and to be worsened by antiviral therapy.


OBJECTIVE
To study pseudodendrites to ascertain a viral presence in the lesions and their response to antiviral therapy.


METHODS
Prospective clinical study.


METHODS
Outpatient and inpatient hospital-based corneal specialty referral practice; molecular virology laboratory.


METHODS
Six patients, aged 33 to 89 years, four with delayed herpes zoster ophthalmicus pseudodendrites and two with herpes zoster ophthalmicus neurotrophic ulceration. One patient was immunosuppressed.


METHODS
Findings from clinical evaluation; polymerase chain reaction assays of lesions and tear film of six patients; polymerase chain reaction and light and electron microscopy of the corneal button from one patient; and the clinical response of four patients to various antiviral drugs.


RESULTS
In contrast to reports in the current literature, delayed pseudodendrites may also be infectious, as they are positive for zoster DNA by polymerase chain reaction and appear responsive to certain antiviral therapy. The corneal button from an immunosuppressed patient had mature and immature viral particles in the basal cells within 2 weeks of transplantation.


CONCLUSIONS
To our knowledge, this is the first report of viral DNA in delayed zoster pseudodendrites. Recurrent viral infection may play a role in this form of zoster keratopathy and warrant antiviral therapy.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D001483:Base Sequence; D003315:Cornea / Q000648:ultrastructure / Q000821:virology; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis* / Q000737:chemistry; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis* / Q000188:drug therapy; D014645:Herpesvirus 3, Human / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007635:Keratitis, Dendritic / Q000175:diagnosis* / Q000188:drug therapy; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies
D000998:Antiviral Agents; D017931:DNA Primers; D004279:DNA, Viral