De Kesel R J, Koppen C, Ieven M, Zeyen T
Middelheim Hospital, Department of Ophthalmology, Antwerp, Belgium.
Cornea. 2001 Mar;20(2):187-90. doi: 10.1097/00003226-200103000-00016.
To present a cluster of four patients with primary graft failure (PGF) who consecutively underwent a penetrating keratoplasty (PKP) during a period of 17 days in one institution. PKP was performed for reasons unrelated to herpes simplex infection. Herpes simplex virus type 1 (HSV-1) is presented as the possible cause of these PGFs.
Viral culture of conjunctival swabs and of a bandage contact lens was performed on VERO, MRC-5, and Hep-2 cells. The four patients underwent subsequent regrafting. Polymerase chain reaction (PCR) for HSV-1 was carried out on aqueous humor and on a sample of iris and cornea with primers. Aqueous humor specimens were pretreated by boiling, and a qiagen extraction was performed according to the instructions of the manufacturer on biopsies of iris and cornea. Immunohistopathology was performed with polyclonal antibodies directed against HSV-1 and -2.
Culture of a conjunctival swab in three patients and culture of a bandage contact lens in the fourth patient were positive for HSV-1. In three of the four patients, PCR was positive for HSV-1 on aqueous humor and corneal graft tissue. PCR on iris tissue was positive in all patients. In three patients, culture for HSV-1 of aqueous humor and of iris tissue could not be carried out because of insufficient sample. Viral culture of the iris tissue in one patient and of the corneal graft in the four patients were negative. Immunohistopathologic examination was positive for HSV-1 in three cases.
These case reports strongly support the hypothesis that HSV-1 can be the cause of PGF.
介绍一组4例原发性移植失败（PGF）患者，在17天内于同一机构连续接受穿透性角膜移植术（PKP）。进行PKP的原因与单纯疱疹感染无关。1型单纯疱疹病毒（HSV-1）被认为是这些PGF的可能病因。
对结膜拭子和绷带式隐形眼镜进行病毒培养，培养于VERO、MRC-5和Hep-2细胞。这4例患者随后接受了再次移植。用引物对房水以及虹膜和角膜样本进行HSV-1的聚合酶链反应（PCR）。房水标本经煮沸预处理，按照制造商的说明对虹膜和角膜活检样本进行qiagen提取。用针对HSV-1和-2的多克隆抗体进行免疫组织病理学检查。
3例患者的结膜拭子培养以及第4例患者的绷带式隐形眼镜培养HSV-1呈阳性。4例患者中有3例房水和角膜移植组织的HSV-1 PCR呈阳性。所有患者的虹膜组织PCR均为阳性。3例患者由于样本不足无法进行房水和虹膜组织的HSV-1培养。1例患者的虹膜组织和4例患者的角膜移植组织的病毒培养均为阴性。3例免疫组织病理学检查HSV-1呈阳性。
这些病例报告有力支持了HSV-1可能是PGF病因的假说。
