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M Halberstadt, JG Garweg; Early Recurrence of Herpetic Keratitis after Corneal Grafting and Its Relation to Slow Local Replication of HSV-1 . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4304.
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Purpose: To test for the presence of signs of viral activity in different sources at the time of transplantation resulting in an early graft infection, in order to define the source of recurrences after transplantation and to identify patients at risk as targets for a potential prophylactic antiviral strategy. Methods: Aqueous humor at surgery, the explant tissue and a shortterm culture fluid of the explant were processed for HSV-1 antigen and DNA detection. Results: 5/25 patients with herpetic keratitis and 2/47 patients with keratitis of unknown origin experienced a recurrence of their keratitis after grafting (p = 0.084). In six cases, viral antigen and viral DNA were detected in the corneal explant tissue as sign of the presence of complete virus. In four out of these six, but none of the remaining cases, a shedding of viral DNA into the explant culture medium was found (p<0.0001). The remaining two cases were under systemic virustatic therapy at the time of operation. Two of the four patients with positive explant cultures developed an early recurrence of herpetic keratitis in the graft, as did 5 out of the 68 remaining ones (p = 0.045). Conclusion: There is a substantial evidence for a slow viral replication in cases with early recurrence of herpetic keratitis after corneal grafting. These cases should be submitted to longterm antiviral therapy to prevent such devasting postoperative course.
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