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Herpes hazard in human keratoplasties: Longitudinal study of 38 recipients by serology, PCR and culture
P. Y. Rodert*, S. Ranger-Rogez*, A. Liekfeld**, F. Denis*, U. Pleyer**, J. P. Adenis*, C. Hartmann**
Purpose: Previous studies have evidenced HSV1 and 2DNA in donor corneal tissue, associated or not to herpes disease. In a cohort of 38 couples corneal donor/cornea! recipients, we have interested in stigmates of HSV, and in postoperative outcome during 6 months.
Material and Methods: Scleral remnants, corneal buttons, recipient aqueous humor and plasma were collected from 38 penetrating keratoplasties. Plasma was collected as well 3 and 6 months postoperatively. HSV serology was tested; HSV PCR was performed on aqueous humor; scleral and corneal sampIes were cut in two parts, one for culture, one for PCR
Results: Three recipients were seronegative for HSV before grafting, and stay negative after grafting. No IgM anti-HSV was evidenced in any patient. PCR amplified HSV DNA from 8 corneal buttons. Neither of them bad proven herpes, but all of them bad long-standing epithelial darnage. Only one was also positive in culture for HSV2, in a patient with stromal scar of unknown etiology .PCR detected as weIl HSV DNA in two donor remnants. Every aqueous humor specimen were negative for PCR. Postoperative herpetic reactivation occured in one patient with no history of herpes, and negative PCR from corneal button and donor's scleral remnants.
Discussion: The presence of HSV DNA is confirmed within plthological and safe cornea! tissue. It could be associated to long-standing epithelial defects and may be infective, but is not associated to clinically proven history of herpes, postoperative complications nor HSV serological profile. The presence of HSV DNA in aqueous humor is thought to occur only in active replication phase. These results highlight the hypothesis of a latency of HSV in situ, or a local production of virions at the end of nerve terminations during latency in ganglia, even in the absence of acute herpetic corneal Iesions.
*Chu Dupuytren, Limoges, France
**Charite and Virchow Klinikum, Berlin, Deutschland