Herpes simplex virus infection in the media of donor corneas during organ culture: frequency and consequences

Background and purpose According to polymerase chain reaction (PCR) studies 2-38% of organ culture donor corneas may contain herpes simplex virus (HSV ) DNA, but there are only 6 reported instances of proven virus replication in a corneoscleral disc. Moreover there are only 6 patients reported in who m primary graft failure and extensive post-operative epithelial defects wer e probably caused by a herpetic infection of the corneal graft. Recently we observed virus replication in a donor cornea with subsequent complete endo thelial necrosis in our cornea bank. The aim of this study was to investiga te the possible correlation between herpetic donor cornea infection and end othelial necrosis in organ culture. Methods To evaluate the frequency of HSV as a reason for endothelial necros is in organ culture we tested the media of 199 donor corneas discarded due to an altered endothelium in the years 1997 to 1999 by PCR for HSV. As a ne gative control group we screened the media of 117 transplanted corneas usin g PCR. Results In the control group we had only negative PCR results, in contrast to the corneas with severe or complete endothelial necrosis where HSV DNA w as detected in 12 media of the corneas of 9 donors. Virus could be cultivat ed out of 7 media. Conclusions (1) HSV replication is a common cause of severe endothelial nec rosis in organ culture corneas. (2) Replication of the virus during organ c ulture comes close to a virus cultivation using the corneoscleral disc as a cell culture. (3) We consider the danger of transplanting active HSV to be very small if critical assessment of the graft prior to surgery is carried out.