Stavridis E, Gatzioufas Z, Hasenfus A, Sauter M, Smola S, Seitz B
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424 Homburg/Saar.
Ophthalmologe. 2012 Oct;109(10):1017-21. doi: 10.1007/s00347-012-2569-0.
Primary corneal graft failure (PCGF) after penetrating keratoplasty (PKP) despite good endothelial cell count of the transplant in organ culture rarely occurs in young patients. A herpes simplex virus type I (HSV-1) infection (transmission through the donor or reactivation by the patient) can lead to PCGF.
We report on a 43-year-old man with pellucid marginal corneal degeneration and neurodermitis, who was underwent penetrating keratoplasty (PKP) on the left eye after acute corneal hydrops in both eyes. A repeat keratoplasty (re-PKP) had to be performed 15 days after the first PKP due to a primary graft failure. A re-re-PKP with simultaneous amniotic membrane transplantation (as a patch) and partial lateral tarsorrhaphy became necessary 4 months after the re-PKP due to melting on the edge of the graft with persistent epithelial defects.
After intensive cooperation between ophthalmologists and pathologists the histopathological findings showed keratocytes which reacted immunohistochemically positive for HSV-1 antigens in the deep corneal stroma of both corneal grafts. The excised own cornea of the patient was histopathologically negative but the DNA-PCR for HSV-1 was weakly positive. After adequate topical and systemic antiviral therapy the third graft has remained clear for 12 months.
In cases of PCGF after normal risk corneal transplantation the possibility of HSV infection should always be considered. After confirmation of the diagnosis with the help of the immunohistochemical tests and/or PCR, an adequate treatment with antiviral medication (acyclovir tablets 2 × 400 mg for more than 1 year) should be administered to the patient after repeat PKP.
穿透性角膜移植术（PKP）后原发性角膜移植失败（PCGF）在年轻患者中很少见，尽管移植片在器官培养中的内皮细胞计数良好。单纯疱疹病毒I型（HSV-1）感染（通过供体传播或患者再激活）可导致PCGF。
我们报告了一名43岁患有透明边缘角膜变性和神经性皮炎的男性，双眼急性角膜水肿后左眼接受了穿透性角膜移植术（PKP）。由于原发性移植失败，首次PKP术后15天不得不进行再次角膜移植（再次PKP）。再次PKP术后4个月，由于移植片边缘融化并伴有持续性上皮缺损，需要进行再次再次PKP，同时进行羊膜移植（作为补片）和部分外侧睑裂缝合术。
经过眼科医生和病理学家的密切合作，组织病理学检查结果显示，在两个角膜移植片的角膜深层基质中，角膜细胞对HSV-1抗原的免疫组化反应呈阳性。患者切除的自身角膜组织病理学检查为阴性，但HSV-1的DNA-PCR检测呈弱阳性。经过适当的局部和全身抗病毒治疗后，第三次移植片在12个月内保持透明。
在正常风险角膜移植术后发生PCGF的病例中，应始终考虑HSV感染的可能性。在通过免疫组化检测和/或PCR确诊后，再次PKP术后应给予患者适当的抗病毒药物治疗（阿昔洛韦片2×400mg，服用超过1年）。
