van Gelderen B E, Van der Lelij A, Treffers W F, van der Gaag R
Department of Ophthalmo- Immunology, The Netherlands Ophthalmic Research Institute, Amsterdam, Netherlands.
Br J Ophthalmol. 2000 Nov;84(11):1238-43. doi: 10.1136/bjo.84.11.1238.
To study the value of polymerase chain reaction (PCR) analysis, to detect viral DNA in recipient corneal buttons taken at the time of penetrating keratoplasty (PKP) in patients with an initial diagnosis of herpetic stromal keratitis (HSK). Since HSK has a tendency to recur, an accurate diagnosis of previous HSK could be the reason to start antiviral treatment immediately, thereby possibly decreasing the number of graft failures due to recurrent herpetic keratitis.
Recipient corneal buttons and aqueous humour (AH) samples were obtained at the time of PKP from HSK patients (n=31) and from other patients (n=78). Eye bank corneas were also used (n=23). Herpes simplex virus type 1 (HSV-1), type 2 (HSV-2), and varicella zoster virus (VZV) infection were assessed by PCR and antibody detection.
The clinical diagnosis HSK could be confirmed by PCR for HSV-1 in 10/31 (32%). In these corneal buttons HSV-2 DNA was detected in 1/31 (3%) and VZV DNA in 6/31 (19%). Intraocular anti-HSV antibody production was detected in 9/28 AH samples tested (32%). In the other patient derived corneas HSV-1 DNA was detected in 13/78 (17%), including eight failed corneal grafts without clinically obvious herpetic keratitis in the medical history. In clear eye bank corneas HSV-1 was detected in 1/23 (4%).
PCR of HSV-1 on corneal buttons can be a useful diagnostic tool in addition to detection of intraocular anti-HSV antibody production. Furthermore, the results were suggestive for the involvement of corneal HSV infection during allograft failure of corneas without previous clinical characteristic signs of herpetic keratitis.
研究聚合酶链反应（PCR）分析在检测初次诊断为疱疹性基质性角膜炎（HSK）患者穿透性角膜移植术（PKP）时所取受体角膜植片中病毒DNA的价值。由于HSK有复发倾向，准确诊断既往HSK可能是立即开始抗病毒治疗的原因，从而有可能减少因复发性疱疹性角膜炎导致的移植失败数量。
在PKP时从HSK患者（n = 31）和其他患者（n = 78）获取受体角膜植片和房水（AH）样本。还使用了眼库角膜（n = 23）。通过PCR和抗体检测评估单纯疱疹病毒1型（HSV - 1）、2型（HSV - 2）和水痘带状疱疹病毒（VZV）感染情况。
PCR检测HSV - 1可在10/31（32%）的患者中确诊临床诊断的HSK。在这些角膜植片中，1/31（3%）检测到HSV - 2 DNA，6/31（19%）检测到VZV DNA。在所检测的28份AH样本中，9份（32%）检测到眼内抗HSV抗体产生。在其他患者来源的角膜中，13/78（17%）检测到HSV - 1 DNA，其中包括8例角膜移植失败且病史中无临床明显疱疹性角膜炎的病例。在清亮的眼库角膜中，1/23（4%）检测到HSV - 1。
除检测眼内抗HSV抗体产生外，对角膜植片进行HSV - 1的PCR检测可成为一种有用的诊断工具。此外，结果提示在既往无疱疹性角膜炎临床特征体征的角膜同种异体移植失败过程中存在角膜HSV感染。
