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Lt Col Glenn C. Cockerham, MC, USAF; Amy E. Krafft, PhD; lan W. McLean, MD

Arch Ophthalmol. 1997;115(5):586-589.

Abstract
Objective
To determine the frequency of herpes simplex virus type 1 (HSV-1) in primary corneal graft failures.

Methods
The clinical data submitted about all cases of corneal graft failure on file at the Armed Forces Institute of Pathology, Washington, DC, from the last 25 years (1970-1995) were evaluated. Cases that met the definition of primary graft failure were examined microscopically and analyzed using polymerase chain reaction (PCR) for the DNA of HSV-1.

Results
Three (2.8%) of the 106 cases of graft failure were primary graft failures. The DNA from 2 of the 3 corneal buttons was amplifiable by PCR analysis and results of the PCR analysis and Southern blotting were positive for HSV-1. None of the results of the PCR analysis and Southern blotting of the corneal buttons from the 3 graft failures occurring later than 30 days were positive for HSV-1. Results of the PCR analysis and Southern blotting indicated that 2 of 3 corneal buttons in the control group of clinically suspected herpetic keratitis were positive for HSV-1. The cornea from the first case of primary graft failure showed acute inflammation with stromal necrosis. The cornea in the second case had loss of endothelium without inflammation.

Conclusions
The finding of DNA from HSV-1 in corneal buttons from 2 cases of primary graft failure supports similar observations by Cleator et al and suggests that HSV-1 may be pathogenic in some cases of primary graft failure. A larger study is needed to determine if HSV-1 is a causative factor in primary graft failure.

Author Affiliations
From the Departments of Ophthalmic Pathology (Drs Cockerham and McLean) and Cellular Pathology (Dr Krafft), Armed Forces Institute of Pathology, Washington, DC. Dr Cockerham is currently a cornea fellow at the Massachusetts Eye and Ear Infirmary, Boston.

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