Culture-proven herpetic keratitis after penetrating keratoplasty in patients with no previous history of herpes disease.
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.
Borderie
Vincent M
VM
Department of Ophthalmology, Hôpital Saint Vincent de Paul, Paris, France. borderie@quinze-vingts.fr
Méritet
Jean-François
JF
Chaumeil
Christine
C
Rozenberg
Flore
F
Baudrimont
Marielle
M
Touzeau
Olivier
O
Bourcier
Tristan
T
Laroche
Laurent
L
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
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral