Recurrent herpes simplex keratitis with concurrent epithelial and stromal involvement. Immunohistochemical and ultrastructural observations
L. M. Holbach, R. L. Font and K. R. Wilhelmus
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030.
A 65-year-old man with recurrent herpetic keratitis underwent corneal
transplantation for persistent nonimmunologic graft failure.
Histopathologic examination of the corneal button revealed an epithelial
dendrite containing Cowdry type A inclusion bodies, moderate stromal edema,
and a retrocorneal fibrous membrane. Immunohistochemical studies
demonstrated herpes simplex virus antigens in epithelial cells bordering
the dendritic defect and in stromal keratocytes. The mean width of corneal
epithelium displaying herpes simplex virus-positive epithelial cells on
either side of the dendritic defect measured 200 +/- 46 microns. By
electron microscopy, herpesvirus particles were identified in epithelial
cells lining the dendrite as well as in stromal keratocytes. Infected
keratocytes were scattered throughout the stroma but were not observed
subjacent to the epithelial dendrite. This study demonstrates that a
recurrent epithelial dendrite can be associated with subclinical stromal
infection of the graft.
