title: Detection of herpes simplex virus type 1 in failed descemet stripping automated endothelial keratoplasty grafts.
abstract: OBJECTIVE
  To determine the prevalence of herpes simplex virus type 1 (HSV-1) DNA in failed Descemet membrane stripping automated endothelial keratoplasty (DSAEK) grafts.
  
  
  METHODS
  A retrospective interventional case series of patients with DSAEK graft failure treated at the New York Eye and Ear Infirmary between January 2009 and July 2012 was performed. Repeat DSAEK, penetrating keratoplasty, or keratoprosthesis procedure was subsequently performed on eyes with failed grafts. All failed grafts were examined immunohistochemically and with qualitative real-time polymerase chain reaction for HSV-1 DNA. In HSV-1-positive cases, corneoscleral donor rims from the original DSAEK procedures were also examined immunohistochemically and with polymerase chain reaction.
  
  
  RESULTS
  Fifty-one failed DSAEK grafts from 50 eyes of 49 patients were identified. Indications for DSAEK were pseudophakic bullous keratopathy (28/51, 55%), Fuchs corneal endothelial dystrophy (12/51, 23%), failed penetrating keratoplasty (7/51, 14%), corneal decompensation from glaucoma (2/51, 4%), herpetic endotheliitis (1/51, 2%), and failed DSAEK (1/51, 2%). Forty-three grafts (83%) were primary DSAEK graft failure. HSV-1 DNA was isolated from 2 of 51 failed DSAEK grafts (4.0%). The corresponding corneoscleral donor rims did not demonstrate the presence of HSV-1.
  
  
  CONCLUSIONS
  Based on our results, HSV-1 infection plays a minor role in DSAEK graft failure. The data suggest that recipient reactivation, rather than donor transmission, plays a role in HSV infection.
authors.affiliation: Departments of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Yin
authors.forename: Andrew
authors.initials: A
authors.lastname: Huang
authors.forename: David
authors.initials: D
authors.lastname: Warrow
authors.forename: David C
authors.initials: DC
authors.lastname: Ritterband
authors.forename: John A
authors.initials: JA
authors.lastname: Seedor
authors.forename: Steven A
authors.initials: SA
authors.lastname: McCormick
authors.forename: Tatyana
authors.initials: T
authors.lastname: Milman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003317:Corneal Dystrophies, Hereditary / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D003886:Descemet Membrane / Q000821:virology; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000821:virology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000821:virology*; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D004279:DNA, Viral