Presence of herpetic DNA in tissue corneal transplant
meaning and implications. Narrative review regarding a case
DOI:
https://doi.org/10.70313/2718.7446.v18.n4.457Keywords:
keratoplasty, herpes, keratitis, primary graft failure, DALKAbstract
Background: Herpes simplex virus (HSV) present in a normal donor corneal button is a cause of primary failure in penetrating keratoplasties. Clinically normal corneas can carry potentially infectious herpetic genome. Recently, herpetic transmission in endothelial keratoplasties has been reported, expanding the known spectrum to different lamellar keratoplasties, especially endothelial ones. This review was motivated after analyzing a case of keratoconus, operated on with deep anterior lamellar keratoplasty (DALK) with primary failure, which, upon investigation, is identified as being caused by HSV, but without a clinical herpetic history. Corneal samples were taken for direct examination, culture, and molecular biology. Additionally, a review of the available literature was conducted. All microbiological studies were negative, except for the polymerase chain reaction (PCR) for Herpes simplex virus. The cornea regained transparency when treated for HSV. The literature review shows the occurrence of cases with primary failures of penetrating and endothelial lamellar keratoplasties due to HSV transmission in patients without herpetic history, being exceptional in anterior lamellar keratoplasties.
In summary, in any primary failure of a keratoplasty, a herpetic cause should be considered, even without prior clinical history or specific herpetic signs. The presence of herpetic DNA will allow for early diagnosis and specific antiviral treatment, with a good chance of success, and in case of graft failure, it will help protect the new keratoplasty.
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