Wenkel H, Rummelt C, Rummelt V, Jahn G, Fleckenstein B, Naumann G O
Department of Ophthalmology, University of Erlangen-Nürnberg, Germany.
Cornea. 1993 Mar;12(2):131-7. doi: 10.1097/00003226-199303000-00007.
This article describes the histopathology, immunohistochemistry, and varicella zoster virus DNA in situ hybridization of 14 corneal buttons obtained from 14 patients (average age 69.0 years) after perforating keratoplasty (four patients) or surgical enucleation (10 patients) at different times after the clinical onset of herpes zoster ophthalmicus (average 58.7 months). The main histopathologic features were intense stromal vascular scarring (12 patients) and granulomatous reaction to Descemet's membrane (nine patients). Using the peroxidase-antiperoxidase method, varicella zoster virus (VZV) antigen could be detected by immunohistochemistry in two patients within epithelial cells of the cornea and in the limbal episclera during the active phase of herpes zoster ophthalmicus. For in situ hybridization we used the 35S-labeled HindIII A and C fragment of VZV and identified viral DNA in five corneal buttons obtained 1 day to 8 years after the clinical onset of infection. Viral DNA was mainly found in mononuclear cells with eosinophilic intracytoplasmic inclusions within vascular stromal scars, in keratocytes, and in epithelial cells of the cornea. Our results show that VZV DNA is detectable in human cornea even 8 years after the clinical onset of herpes zoster ophthalmicus and may indicate VZV persistence in a latent form in corneal tissue or reactivation of the virus from an endogenous or exogenous source causing a severe and often recurrent keratitis in the progress of herpes zoster ophthalmicus.
本文描述了从14例患者（平均年龄69.0岁）获取的14个角膜植片的组织病理学、免疫组织化学及水痘带状疱疹病毒DNA原位杂交情况。这些患者在眼部带状疱疹临床发病后不同时间（平均58.7个月）接受了穿透性角膜移植术（4例）或眼球摘除术（10例）。主要组织病理学特征为强烈的基质血管瘢痕形成（12例）和对Descemet膜的肉芽肿反应（9例）。采用过氧化物酶-抗过氧化物酶法，在眼部带状疱疹活动期，通过免疫组织化学可在2例患者的角膜上皮细胞及角膜缘结膜中检测到水痘带状疱疹病毒（VZV）抗原。对于原位杂交，我们使用了35S标记的VZV HindIII A和C片段，在感染临床发病后1天至8年获取的5个角膜植片中鉴定出病毒DNA。病毒DNA主要存在于血管基质瘢痕内有嗜酸性胞质内包涵体的单核细胞、角膜细胞及角膜上皮细胞中。我们的结果表明，即使在眼部带状疱疹临床发病8年后，仍可在人角膜中检测到VZV DNA，这可能表明VZV以潜伏形式持续存在于角膜组织中，或从内源性或外源性来源重新激活病毒，在眼部带状疱疹病程中导致严重且常复发的角膜炎。
