External Disease Service, Moorfields Eye Hospital, London, United Kingdom.
Eye Bank, Moorfields Eye Hospital, London, United Kingdom.
Eye (Lond). 2019 May;33(5):833-837. doi: 10.1038/s41433-018-0331-9. Epub 2019 Jan 8.
Cytomegalovirus (CMV) endotheliitis is a significant cause for acute corneal allograft rejection in East Asian populations, where there is a high CMV seroprevalence. To determine how frequently CMV is associated with corneal graft failure in the UK, we looked for the presence of CMV DNA in grafts that had failed and had been removed at repeat keratoplasty. We also looked for CMV DNA in corneal rims discarded after corneal transplantation.
In this retrospective study, we identified 54 cases of corneal graft failure following endothelial rejection and 38 control grafts that had failed without a history of endothelial rejection. For these groups archived formalin-fixed paraffin-embedded (FFPE) tissue samples were retrieved. We also prospectively examined 80 non-fixed cornea rims following transplantation surgery. In all samples nested quantitative PCR was used to identify CMV, herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA. We also used in situ hybridisation to examine for CMV DNA in the FFPE samples.
No CMV or VZV DNA was detected in any of the archived case or control FFPE tissues. One corneal rim from the control group was positive for HSV. In situ hybridisation for CMV was negative for CMV in all FFPE samples. No CMV, VZV or HSV DNA was detected in the donor corneal rim samples.
CMV DNA was not identified in excised failed corneal tissue or from tissue prior to transplantation. We infer that CMV infection is not a significant factor risk for corneal graft failure in the United Kingdom.
巨细胞病毒（CMV）血管内皮炎是东亚人群中急性角膜同种异体移植排斥反应的一个重要原因，在这些人群中 CMV 血清阳性率较高。为了确定 CMV 在英国与角膜移植物失功的关联频率，我们在重复角膜移植时寻找失功且已被移除的移植物中 CMV DNA 的存在情况。我们还在角膜移植后丢弃的角膜边缘寻找 CMV DNA。
在这项回顾性研究中，我们鉴定了 54 例因内皮排斥而导致角膜移植物失功的病例和 38 例无内皮排斥史但移植物失功的对照病例。对于这些病例，我们获取了存档的福尔马林固定石蜡包埋（FFPE）组织样本。我们还前瞻性地检查了 80 例移植手术后未固定的角膜边缘。在所有样本中，均使用巢式定量 PCR 来鉴定 CMV、单纯疱疹病毒（HSV）和水痘-带状疱疹病毒（VZV）DNA。我们还使用原位杂交来检查 FFPE 样本中的 CMV DNA。
在所有存档的病例或对照 FFPE 组织中均未检测到 CMV 或 VZV DNA。对照组的一个角膜边缘样本 HSV 阳性。在所有 FFPE 样本中，CMV 的原位杂交均为 CMV 阴性。供体角膜边缘样本未检测到 CMV、VZV 或 HSV DNA。
在切除的失功角膜组织或移植前的组织中均未鉴定出 CMV DNA。我们推断，CMV 感染不是英国角膜移植物失功的一个重要危险因素。
