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Dan Yin, Tatyana Milman; Detection Of Herpes Simplex Virus (hsv) In Failed Descemet's Stripping Automated Endothelial Keratoplasty (dsaek) Grafts By Real-time Polymerase Chain Reaction (pcr). Invest. Ophthalmol. Vis. Sci. 2012;53(14):4952.
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To determine the presence of HSV-1 in failed descemet's stripping automated endothelial keratoplasty (DSAEK) grafts and to describe the clinicopathologic findings.
A retrospective interventional case series study of patients with failed DSAEK grafts treated at New York Eye and Ear Infirmary between December 2006 and October 2011 was performed. Repeat DSAEK or penetrating keratoplasty (PK) was performed on eyes with failed grafts. All failed grafts and corneoscleral donor rims from original DSAEK procedures were examined immunohistochemically and with real-time polymerase chain reaction (PCR) for presence of HSV-1.
This study included 80 eyes of 79 patients with failed DSAEK grafts. Of the studied samples for PCR analysis, HSV-1 DNA was isolated from one failed DSAEK graft, managed with PK following clinically suspected herpetic keratitis. Histopathologic evaluation showed moderate subacute inflammatory infiltrate in both explanted donor and recipient lenticles. Immuoreactivity for HSV-1 antigen was present both in the recipient cornea and donor DSAEK lenticle, but not in the corneoscleral rim, consistent with reactivation of HSV-1 from the recipient’s cornea.
Our data suggests that HSV-1 infection plays a minor role in DSAEK failure. This contrasts with a prior study reporting 33% rate of HSV-1 DNA isolation in failed PK grafts. The much lower rate of HSV-1 infection in failed DSAEK grafts may reflect the less invasive nature of surgical technique as compared to PK and decreased dose/duration of immunosuppressive medications. Additional prospective studies with a larger patient pool should be performed to further examine the role of HSV reactivation in DSAEK failure.
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