title: Primary graft failure : a clinicopathologic and molecular analysis.
abstract: OBJECTIVE
  Primary graft failure (PGF) corneal tissues were analyzed for herpes simplex virus (HSV) and varicella-zoster virus (VZV).
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  Formalin-fixed, paraffin-embedded tissue of 21 donor corneas and 14 recipient corneas of PGF cases, as well as 10 control corneas.
  
  
  METHODS
  Clinical, histologic, immunohistochemical, polymerase chain reaction (PCR), and, in selected cases, transmission electron microscopic characteristics were studied.
  
  
  METHODS
  Evidence of HSV or VZV in donor tissues.
  
  
  RESULTS
  Median patient age was 65 years, and median donor age was 48 years. Donor cornea parameters, including endothelial cell counts, death-to-preservation time, and time in storage, were generally within accepted standards. Stromal edema was found in all 21 donor corneas with PGF. Eighteen donor corneas demonstrated severely reduced or absent endothelium and mild to moderate lymphocytic infiltration without necrosis. Three donor corneas (14%) had necrotizing stromal keratitis (NSK) with keratic precipitates. Positive immunohistochemical staining of keratocytes for HSV was present in two of two donor corneas with NSK and was negative in 18 other donor corneas. Polymerase chain reaction analysis revealed the DNA of HSV type 1 (HSV1) in all donor corneas with NSK and in four donor corneas without NSK (33%). Recipient corneal tissue was negative for HSV1 DNA in three patients with NSK and positive in two of the four other PCR-positive patients. Transmission electron microscopy analysis showed viral particles in two donor corneas with NSK. Polymerase chain reaction analysis revealed no evidence of HSV type 2 or VZV in any cornea. All control corneas were negative for viral DNA. Sixteen corneas remained clear and two had failed after regraft for PGF, with a median follow-up of 3.6 years.
  
  
  CONCLUSIONS
  Herpes simplex virus type 1 DNA was present in 33% of patients of PGF. Herpetic stromal keratitis was found in some failed corneas; the lack of HSV in the paired recipient suggests importation within the donor cornea. The overall prognosis for regrafting after PGF is good.
authors.affiliation: Ophthalmology Service, Andrews Air Force Base, Camp Springs, Maryland, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: Cockerham
authors.forename: K
authors.initials: K
authors.lastname: Bijwaard
authors.forename: Z M
authors.initials: ZM
authors.lastname: Sheng
authors.forename: A A
authors.initials: AA
authors.lastname: Hidayat
authors.forename: R L
authors.initials: RL
authors.lastname: Font
authors.forename: I W
authors.initials: IW
authors.lastname: McLean
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015139:Blotting, Southern; D002648:Child; D003315:Cornea / Q000648:ultrastructure / Q000821:virology*; D017931:DNA Primers / Q000737:chemistry; D015342:DNA Probes / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006084:Graft Rejection / Q000473:pathology / Q000601:surgery / Q000821:virology*; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification* / Q000648:ultrastructure; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification / Q000648:ultrastructure; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification / Q000648:ultrastructure; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D016849:Keratitis, Herpetic / Q000473:pathology / Q000601:surgery / Q000821:virology*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D014771:Virion / Q000648:ultrastructure
chemical_list: D017931:DNA Primers; D015342:DNA Probes; D004279:DNA, Viral