D. Pavanlangston et al., DELAYED HERPES-ZOSTER PSEUDODENDRITES - POLYMERASE CHAIN-REACTION DETECTION OF VIRAL-DNA AND A ROLE FOR ANTIVIRAL THERAPY, Archives of ophthalmology, 113(11), 1995, pp. 1381-1385
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.