Abstract
Purpose :
To discover the occurrence of Herpes Simplex Virus type 1 and 2 (HSV) and Varicella Zoster Virus (VZV) DNA in transplanted corneas using polymerase chain reaction (PCR), and to determine the relationship between latent HSV-1 and VZV with the occurrence of herpetic eye disease in recipients and graft failure.
Methods :
Eighty-eight (88) corneas were morphologically evaluated before surgery by slit-lamp examination and CellChek® specular microscopy. Excluded corneas were tested for HBV, HCV, and HIV by donor serological assessment, a low cell count (under 2,300 cells /mm3), corneal scars, and abnormal endothelial cell morphology. Transplanted corneas were sampled for HSV 1,2 and VZV DNA by PCR. All eyes transplanted with the donor corneas were evaluated and followed for corneal transparency, endothelial cells morphology, and number by specular microscopy signs for ocular inflammation, intraocular pressure, and anterior segment optical coherence tomography (OCT).
Results :
HSV-1 DNA was detected in five transplanted corneas out of the 88 that were examined (5.7%). HSV-2 was not detected in any cornea, and VZV in one cornea out of 82 examined (1.2%). Four of the positive corneas were used in descemet membrane endothelial keratoplasty (DMEK) surgeries. One for a combined DMEK/anterior vitrectomy/ iridoplasty surgery and one as a tectonic graft. One recipient (16.7%) developed herpes dendritic epitheliopathy and keratouveitis 12 months after transplant though the graft remained clear after treatment. One cornea was used for a tectonic graft and stayed edematous at 20 months follow - up. The rest of the corneas stayed clear.
Conclusions :
Herpes viruses, especially HSV-1, may be PCR DNA positive in morphologically normal donor corneas. Recipients of herpes positive corneal grafts are at risk for herpetic eye disease. Further evaluation with a bigger sample size and a longer follow-up time is needed to establish a clinical correlation to donor graft survival and to recipient ocular infection with HSV. Positive samples will be evaluated for reverse transcriptase PCR (RT-PCR) to evaluate HSV latency and infectivity.
This is a 2021 ARVO Annual Meeting abstract.