title: Culture-proven herpetic keratitis after penetrating keratoplasty in patients with no previous history of herpes disease.
abstract: OBJECTIVE
  To report three cases of herpetic infection in recipients of organ-cultured donor corneas among 586 consecutive corneal transplantation procedures.
  
  
  METHODS
  Three patients with no history of symptomatic herpes infection underwent corneal transplantation for keratoconus (2 patients) and Fuchs dystrophy (1 patient). Two patients developed keratouveitis and primary graft failure. The third patient developed dendritic keratitis in the graft. Culture of corneal scrapings and the patient's bandage contact lens were positive for herpes simplex virus type 1 (HSV-1). Donor and recipient sera were tested for HSV serology by EIA. Recipient corneal buttons were studied by means of transmission electron microscopy and immunohistochemistry. The three HSV-1 strains were genotyped by sequencing part of a variable antigenic domain of glycoprotein B (gB).
  
  
  RESULTS
  None of the donor corneas showed endothelial cell necrosis after organ culture. All keratoplasties performed with the three mate donor corneas had an uncomplicated course. All three donor sera were positive for HSV. Preoperative recipient sera were positive for HSV. Analysis of the recipient corneal buttons showed no evidence of herpetic infection. Sequence analysis revealed three different gB genotypes.
  
  
  CONCLUSIONS
  Ascertaining that a postoperative herpetic infection in a corneal transplant originates from the donor tissue is still difficult. Although some features of the reported cases suggest donor-to-host transmission of herpes simplex virus, the recipients could have been the source of the virus.
authors.affiliation: Department of Ophthalmology, Hôpital Saint Vincent de Paul, Paris, France. borderie@quinze-vingts.fr
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Borderie
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Méritet
authors.forename: Christine
authors.initials: C
authors.lastname: Chaumeil
authors.forename: Flore
authors.initials: F
authors.lastname: Rozenberg
authors.forename: Marielle
authors.initials: M
authors.lastname: Baudrimont
authors.forename: Olivier
authors.initials: O
authors.lastname: Touzeau
authors.forename: Tristan
authors.initials: T
authors.lastname: Bourcier
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D003315:Cornea / Q000187:drug effects / Q000473:pathology / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007124:Immunoenzyme Techniques; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D007640:Keratoconus / Q000601:surgery; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques; D011183:Postoperative Complications; D014019:Tissue Donors
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral