Transcript Resident Name, MD

Role of HSV Infection in the
Histopathology of Failed DSAEK
Authors:
Julia P. Shulman, MD; Mark Kropinak, MD;
David C. Ritterband, MD; Henry D. Perry, MD;
John A. Seedor, MD; Steven A. McCormick,
MD; Tatyana Milman, MD
Authors have no financial interest
Purpose
• To determine the role of HSV in graft
failure by analyzing failed Descemet
Stripping Automated Endothelial
Keratoplasty (DSAEK) lenticles with
histopathology and immunohistochemistry.
• To compare histopathology of HSV
positive and HSV negative failed lenticles.
Methods
Retrospective, single-center, nonrandomized consecutive series, in which
24 failed DSAEK lenticles from three
surgeons were analyzed to establish the
rate of HSV infection and lenticle
histopathology.
Results
• The average patient age in this series was
75 (range, 56-90).
• Indications for DSAEK included
– Fuchs’ endothelial dystrophy (11)
– Pseudophakic bullous keratopathy (7)
– Failed graft (2)
– Corneal decompensation after multiple
previous surgeries (2)
Results
• 3 lenticles were found to be HSV positive
– (3/24,13%) by immuno-histochemistry
– none had a prior clinical history of HSV keratitis.
• HSV positive failed lenticles
– had a lower average endothelial cell count
– were thinner than failed HSV negative lenticles.
Results
Average ECC (cells/hpf)
Lenticle Thickness (nm)
HSV positive
1.65
425 +/- 156
HSV negative
2.25
449.69 +/- 217
Table I. Comparison of average endothelial cell count (ECC) and
lenticle thickness in HSV positive and negative lenticles
Results
• Some degree of chronic stromal
inflammation was associated with all
lenticles irrespective of HSV status, and
was not a significant parameter in
identifying HSV positive lenticles.
• HSV positive lenticles were associated
with a greater degree of interface fibrosis
as compared to HSV negative lenticles.
Results
Acute and chronic
inflammation observed in
a graft with HSV-1
immunoreactivity
Figure I
Conclusions
• While the presence of HSV-1 antigens has been
observed in one third of primary penetrating keratoplasty
failures, it has not previously been documented in failed
DSAEKs.
• HSV may be a risk factor for lenticle dislocation though
larger studies are needed to confirm the statistical
significance of these observations.
• The HSV positive lenticles were found to be thinner
despite lower endothelial counts, suggesting that HSV
infectivity may affect thickness in a mechanism not
mediated through endothelial cell count and hydration.
References
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Terry MA. Endothelial keratoplasty: history, current state, and future
directions. Cornea 2006; 25:873-78.
Price FW Jr, Price MO. Descemet’s stripping with endothelial keratoplasty in
200 eyes: early challenges and techniques to enhance donor adherence. J
Cataract Refract Surg 2006;32:411-8.
Chen ES, Terry MA, Shamie N, et al. Descemet-stripping automated
endothelial keratoplasty: six month results in a prospective study of 100
eyes. Cornea 2008;27:514-20.
Terry MA, Chen ES, Shamie N, et al. Endothelial loss after Descemet’s
stripping endothelial keratoplasty in a large prospective series.
Ophthalmology 2008;115:488-96.
Terry MA, Hoar KL, Wall J, Ousley P. Histology of dislocation in endothelial
keratoplasty (DSEK and DLEK): a laboratory based, surgical solution to
dislocation in 100 consecutive DSEK cases. Cornea 2006;25:926-32.
Mehta JS, Chua J, Poh R, et al. Primary graft failure after Descemetstipping automated endothelial keratoplasty: clinico-pathological study.
Cornea. 2008;27:722-6.