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

Abstract

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 whom primary graft failure and extensive post-operative epithelial defects were probably caused by a herpetic infection of the corneal graft. Recently we observed virus replication in a donor cornea with subsequent complete endothelial necrosis in our cornea bank. The aim of this study was to investigate the possible correlation between herpetic donor cornea infection and endothelial necrosis in organ culture. To evaluate the frequency of HSV as a reason for endothelial necrosis 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 negative control group we screened the media of 117 transplanted corneas using PCR. In the control group we had only negative PCR results, in contrast to the corneas with severe or complete endothelial necrosis where HSV DNA was detected in 12 media of the corneas of 9 donors. Virus could be cultivated out of 7 media. (1) HSV replication is a common cause of severe endothelial necrosis in organ culture corneas. (2) Replication of the virus during organ culture 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.