DELAYED HERPES-ZOSTER PSEUDODENDRITES - POLYMERASE CHAIN-REACTION DETECTION OF VIRAL-DNA AND A ROLE FOR ANTIVIRAL THERAPY

Background: The late-onset pseudodendrites, delayed corneal mucous pla ques, of herpes tester ophthalmicus are reported to be of mechanical o r immune origin and to be worsened by antiviral therapy. Objective: To study pseudodendrites to ascertain a viral presence in the lesions an d their response to antiviral therapy. Design: Prospective clinical st udy. Setting: Outpatient and inpatient hospital-based corneal specialt y referral practice; molecular virology laboratory. Patients: Six pati ents, aged 33 to 89 years, four with delayed herpes tester ophthalmicu s pseudodendrites and two with herpes tester ophthalmicus neurotrophic ulceration. One patient was immunosuppressed. Main Outcome Measures: Findings from clinicalevaluation; polymerase chain reaction assays of lesions and tear film of six patients; polymerase chain reaction and l ight and electron microscopy of the corneal button from one patient; a nd the clinical response of four patients to various antiviral drugs. Results: In contrast to reports in the current literature, Delayed pse udodendrites may also be infectious, as they are positive for tester D NA by polymerase chain reaction and appear responsive to certain antiv iral therapy. The corneal button from an immunosuppressed patient had mature and immature viral particles in the basal cells within 2 weeks of transplantation. Conclusions: To our knowledge, this is the first r eport of viral DNA in delayed tester pseudodendrites. Recurrent viral infection may play a role in this form of tester keratopathy and warra nt antiviral therapy.