Borderie Vincent M, Méritet Jean-François, Chaumeil Christine, Rozenberg Flore, Baudrimont Marielle, Touzeau Olivier, Bourcier Tristan, Laroche Laurent
Department of Ophthalmology, Hôpital Saint Vincent de Paul, Paris, France.
Cornea. 2004 Mar;23(2):118-24. doi: 10.1097/00003226-200403000-00003.
To report three cases of herpetic infection in recipients of organ-cultured donor corneas among 586 consecutive corneal transplantation procedures.
Three patients with no history of symptomatic herpes infection underwent corneal transplantation for keratoconus (2 patients) and Fuchs dystrophy (1 patient). Two patients developed keratouveitis and primary graft failure. The third patient developed dendritic keratitis in the graft. Culture of corneal scrapings and the patient's bandage contact lens were positive for herpes simplex virus type 1 (HSV-1). Donor and recipient sera were tested for HSV serology by EIA. Recipient corneal buttons were studied by means of transmission electron microscopy and immunohistochemistry. The three HSV-1 strains were genotyped by sequencing part of a variable antigenic domain of glycoprotein B (gB).
None of the donor corneas showed endothelial cell necrosis after organ culture. All keratoplasties performed with the three mate donor corneas had an uncomplicated course. All three donor sera were positive for HSV. Preoperative recipient sera were positive for HSV. Analysis of the recipient corneal buttons showed no evidence of herpetic infection. Sequence analysis revealed three different gB genotypes.
Ascertaining that a postoperative herpetic infection in a corneal transplant originates from the donor tissue is still difficult. Although some features of the reported cases suggest donor-to-host transmission of herpes simplex virus, the recipients could have been the source of the virus.
在连续586例角膜移植手术中，报告3例接受器官培养供体角膜的受者发生疱疹感染的病例。
3例无疱疹感染症状史的患者因圆锥角膜（2例）和富克斯营养不良（1例）接受角膜移植。2例发生角膜葡萄膜炎和原发性移植失败。第3例患者移植片中出现树枝状角膜炎。角膜刮片和患者的绷带式隐形眼镜培养结果显示单纯疱疹病毒1型（HSV-1）阳性。通过酶免疫测定法检测供体和受者血清中的HSV血清学。通过透射电子显微镜和免疫组织化学对受者角膜植片进行研究。通过对糖蛋白B（gB）可变抗原结构域的部分进行测序，对3株HSV-1菌株进行基因分型。
器官培养后，所有供体角膜均未显示内皮细胞坏死。使用这3个匹配供体角膜进行的所有角膜移植手术过程均无并发症。所有3例供体血清HSV均呈阳性。术前受者血清HSV呈阳性。对受者角膜植片的分析未发现疱疹感染迹象。序列分析显示3种不同的gB基因型。
确定角膜移植术后的疱疹感染源自供体组织仍然困难。尽管报告病例的一些特征提示单纯疱疹病毒从供体传播至宿主，但受者也可能是病毒的来源。
