Primary graft failure - A clinicopathologic and molecular analysis

Objective: Primary graft failure (PGF) corneal tissues were analyzed for he rpes simplex virus (HSV) and varicella-zoster virus (VZV). Design: Retrospective, noncomparative case series. Materials: Formalin-fixe d, paraffin-embedded tissue of 21 donor corneas and 14 recipient corneas of PGF cases, as well as 10 control corneas. Methods: Clinical, histologic, immunohistochemical, polymerase chain reacti on (PCR), and, in selected cases, transmission electron microscopic charact eristics were studied. Main Outcome Measures: Evidence of HSV or VZV in donor tissues. Results: Median patient age was 65 years, and median donor age was 48 years . Donor cornea parameters, including endothelial cell counts, death-to-pres ervation time, and time in storage, were generally within accepted standard s. Stromal edema was found in all 21 donor corneas with PGF, Eighteen donor corneas demonstrated severely reduced or absent endothelium and mild to mo derate lymphocytic infiltration without necrosis. Three donor corneas (14%) had necrotizing stromal keratitis (NSK) with keratic precipitates. Positiv e immunohistochemical staining of keratocytes for HSV was present in two of two donor corneas with NSK and was negative in 18 other donor corneas, Pol ymerase chain reaction analysis revealed the DNA of HSV type 1 (HSV1) in al l donor corneas with NSK and in four donor corneas without NSK (33%), Recip ient corneal tissue was negative for HSV1 DNA in three patients with NSK an d positive in two of the four other PCR-positive patients. Transmission ele ctron microscopy analysis showed viral particles in two donor corneas with NSK, Polymerase chain reaction analysis revealed no evidence of HSV type 2 or VZV in any cornea. All control corneas were negative for viral DNA, Sixt een corneas remained clear and two had failed after regraft for PGF, with a median follow-up of 3.6 years. Conclusions: Herpes simplex virus type 1 DNA was present in 33% of patients of PGF, Herpetic stromal keratitis was found in some failed corneas; the l ack of HSV in the paired recipient suggests importation within the donor co rnea. The overall prognosis for regrafting after PGF is good. Ophthalmology 2000;107:2083-2091 (C) 2000 by the American Academy of Ophthalmology.