Cockerham G C, Bijwaard K, Sheng Z M, Hidayat A A, Font R L, McLean I W
Ophthalmology Service, Andrews Air Force Base, Camp Springs, Maryland, USA.
Ophthalmology. 2000 Nov;107(11):2083-90;discussion 2090-1. doi: 10.1016/s0161-6420(00)00361-4.
Primary graft failure (PGF) corneal tissues were analyzed for herpes simplex virus (HSV) and varicella-zoster virus (VZV).
Retrospective, noncomparative case series.
Formalin-fixed, paraffin-embedded tissue of 21 donor corneas and 14 recipient corneas of PGF cases, as well as 10 control corneas.
Clinical, histologic, immunohistochemical, polymerase chain reaction (PCR), and, in selected cases, transmission electron microscopic characteristics were studied.
Evidence of HSV or VZV in donor tissues.
Median patient age was 65 years, and median donor age was 48 years. Donor cornea parameters, including endothelial cell counts, death-to-preservation time, and time in storage, were generally within accepted standards. Stromal edema was found in all 21 donor corneas with PGF. Eighteen donor corneas demonstrated severely reduced or absent endothelium and mild to moderate lymphocytic infiltration without necrosis. Three donor corneas (14%) had necrotizing stromal keratitis (NSK) with keratic precipitates. Positive immunohistochemical staining of keratocytes for HSV was present in two of two donor corneas with NSK and was negative in 18 other donor corneas. Polymerase chain reaction analysis revealed the DNA of HSV type 1 (HSV1) in all donor corneas with NSK and in four donor corneas without NSK (33%). Recipient corneal tissue was negative for HSV1 DNA in three patients with NSK and positive in two of the four other PCR-positive patients. Transmission electron microscopy analysis showed viral particles in two donor corneas with NSK. Polymerase chain reaction analysis revealed no evidence of HSV type 2 or VZV in any cornea. All control corneas were negative for viral DNA. Sixteen corneas remained clear and two had failed after regraft for PGF, with a median follow-up of 3.6 years.
Herpes simplex virus type 1 DNA was present in 33% of patients of PGF. Herpetic stromal keratitis was found in some failed corneas; the lack of HSV in the paired recipient suggests importation within the donor cornea. The overall prognosis for regrafting after PGF is good.
对原发性移植失败（PGF）的角膜组织进行单纯疱疹病毒（HSV）和水痘-带状疱疹病毒（VZV）分析。
回顾性、非对照病例系列。
21例PGF病例的供体角膜和14例受体角膜的福尔马林固定、石蜡包埋组织，以及10例对照角膜。
研究临床、组织学、免疫组织化学、聚合酶链反应（PCR），并在选定病例中研究透射电子显微镜特征。
供体组织中HSV或VZV的证据。
患者中位年龄为65岁，供体中位年龄为48岁。供体角膜参数，包括内皮细胞计数、死亡至保存时间和储存时间，一般在公认标准范围内。所有21例PGF供体角膜均发现基质水肿。18例供体角膜显示内皮严重减少或缺失，伴有轻度至中度淋巴细胞浸润但无坏死。3例（14%）供体角膜有坏死性基质角膜炎（NSK）伴角膜后沉着物。2例有NSK的供体角膜中，角膜细胞HSV免疫组织化学染色呈阳性，其他18例供体角膜呈阴性。聚合酶链反应分析显示，所有有NSK的供体角膜以及4例无NSK的供体角膜（33%）中均有1型单纯疱疹病毒（HSV1）的DNA。3例有NSK的患者受体角膜组织HSV1 DNA为阴性，其他4例PCR阳性患者中有2例为阳性。透射电子显微镜分析显示2例有NSK的供体角膜中有病毒颗粒。聚合酶链反应分析未发现任何角膜中有2型单纯疱疹病毒或VZV的证据。所有对照角膜病毒DNA均为阴性。16例角膜保持透明，2例PGF再次移植后失败，中位随访时间为3.6年。
33%的PGF患者存在1型单纯疱疹病毒DNA。在一些失败的角膜中发现疱疹性基质角膜炎；配对受体中缺乏HSV表明是在供体角膜内传入的。PGF后再次移植的总体预后良好。
