title: [Ping-pong transmission of herpes simplex virus 1 following corneal transplantation].
abstract: BACKGROUND
  Primary corneal graft failure (PCGF) after penetrating keratoplasty (PKP) despite good endothelial cell count of the transplant in organ culture rarely occurs in young patients. A herpes simplex virus type I (HSV-1) infection (transmission through the donor or reactivation by the patient) can lead to PCGF.
  
  
  METHODS
  We report on a 43-year-old man with pellucid marginal corneal degeneration and neurodermitis, who was underwent penetrating keratoplasty (PKP) on the left eye after acute corneal hydrops in both eyes. A repeat keratoplasty (re-PKP) had to be performed 15 days after the first PKP due to a primary graft failure. A re-re-PKP with simultaneous amniotic membrane transplantation (as a patch) and partial lateral tarsorrhaphy became necessary 4 months after the re-PKP due to melting on the edge of the graft with persistent epithelial defects.
  
  
  RESULTS
  After intensive cooperation between ophthalmologists and pathologists the histopathological findings showed keratocytes which reacted immunohistochemically positive for HSV-1 antigens in the deep corneal stroma of both corneal grafts. The excised own cornea of the patient was histopathologically negative but the DNA-PCR for HSV-1 was weakly positive. After adequate topical and systemic antiviral therapy the third graft has remained clear for 12 months.
  
  
  CONCLUSIONS
  In cases of PCGF after normal risk corneal transplantation the possibility of HSV infection should always be considered. After confirmation of the diagnosis with the help of the immunohistochemical tests and/or PCR, an adequate treatment with antiviral medication (acyclovir tablets 2 × 400 mg for more than 1 year) should be administered to the patient after repeat PKP.
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424 Homburg/Saar. evangelos.stavridis@uks.eu
authors.forename: E
authors.initials: E
authors.lastname: Stavridis
authors.forename: Z
authors.initials: Z
authors.lastname: Gatzioufas
authors.forename: A
authors.initials: A
authors.lastname: Hasenfus
authors.forename: M
authors.initials: M
authors.lastname: Sauter
authors.forename: S
authors.initials: S
authors.lastname: Smola
authors.forename: B
authors.initials: B
authors.lastname: Seitz
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D003299:Cooperative Behavior; D060527:Corneal Keratocytes / Q000473:pathology / Q000821:virology; D016039:Corneal Transplantation; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D006561:Herpes Simplex / Q000276:immunology; D006801:Humans; D033183:Interdisciplinary Communication; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000473:pathology / Q000635:transmission*; D015948:Keratoplasty, Penetrating; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D012086:Reoperation
chemical_list: D000956:Antigens, Viral