Search

Purpose: To describe the demographic features and clinical characteristics of patients with herpes keratitis (HK) and limbal stem cell deficiency (LSCD) and identify possible factors associated with development of LSCD after HK., Methods: In this retrospective case-series study, records of patients with a clinical diagnosis of HK seen at Massachusetts Eye and Ear over a 5-year period were reviewed for evidence of LSCD. Patient demographics, medical history, treatment, and best-corrected visual acuities (BCVAs) were recorded., Results: We identified 626 patients with HK. Fifty-seven had been diagnosed with LSCD (9.3%). Thirteen percent of patients with herpes zoster keratitis (N= 25) and 7% of patients with herpes simplex keratitis (N= 32) had LSCD (P = 0.01). Keratitis caused by herpes zoster virus [odds ratios (OR), 1.77; 95% confidence interval (CI), 0.97-3.19; P = 0.01], stromal involvement (OR, 2.28; 95% CI, 1.27-4.18; P = 0.02), and the use of topical antihypertensives (OR, 2.28; 95% CI, 1.27-4.18; P = 0.02) were found to be associated with a higher likelihood of developing LSCD. The final logarithm of the minimum angle of resolution (LogMAR) BCVA was significantly lower in patients with LSCD compared with those without LSCD with a mean BCVA of 1.34 ± 1.52 LogMar (∼20/200) as compared to 0.18 ± 0.54 LogMar (∼20/30 ± 20/60) in those patients without LSCD (P = 0.005)., Conclusions: Our data suggest that HK may be a risk factor for development of LSCD. Patients with HK should be monitored for the development of LSCD to reduce the risk of chronic ocular surface morbidity., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To report the clinical outcome and postoperative course of Descemet membrane endothelial keratoplasty (DMEK) in irreversible corneal edema due to herpes simplex virus (HSV) endotheliitis., Methods: This is a retrospective, noncomparative, interventional case series. Nineteen eyes of 19 patients underwent standard DMEK combined with cataract surgery (triple DMEK) between May 2016 and April 2018. All patients received perioperative oral acyclovir (ACV) and prednisolone. Patients were followed up on day 1, on day 7, at 1 month, and then at 3 monthly intervals. Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), graft clarity, pachymetry, and endothelial cell loss after 1 year were recorded. Postoperative complications and HSV recurrence were noted until the last follow-up visit., Results: All eyes were phakic with variable grades of cataract with a preoperative BSCVA of 1.0 logarithm of the minimum angle of resolution or worse. The mean follow-up period was 19.3 ± 5.4 months. After 1 year, 14 (73.7%) eyes achieved a BSCVA of 0.3 or better. Seventeen (89.5%) patients had a clear graft at the last visit without any rejection episode. One graft failed after 16 months. After 3 months, the mean pachymetry reduced from 667.1 ± 62.1 to 512.8 ± 27.1 μm (P < 0.001). The mean endothelial cell loss after 1 year was 36.7 ± 13.4%. Three (15.8%) eyes had recurrence: one with recurrent endotheliitis and 2 with dendritic keratitis despite oral ACV, which responded to oral valacyclovir and ACV eye ointment. One patient had re-recurrence of endotheliitis after 20 months., Conclusions: DMEK in persistent corneal edema after HSV endotheliitis remains challenging but has encouraging outcomes. The postoperative course may be complicated by HSV recurrence. Prophylactic oral antivirals for 1 year or more and topical antivirals are useful for the prevention of recurrence.

Purpose: We describe the first case of a novel surgical technique of mini-invasive corneal neurotization (MICORNE) using the lateral antebrachial cutaneous nerve as a graft nerve and the contralateral supraorbital nerve as a donor nerve in a herpetic patient with a neurotrophic keratopathy (NK)., Methods: A MICORNE procedure was performed in a 32-year-old man with a 5-year history of herpes simplex virus (HSV)-related NK in the right eye (RE). Visual acuity and corneal sensation were assessed over 9 months of follow-up. HSV-1 and HSV-2 genomes were screened preoperatively and postoperatively in the patient's tears using the quantitative polymerase chain reaction technique. A high does of the oral antiviral prophylaxis was prescribed during the follow-up., Results: Preoperative best-corrected visual acuity was 20/200 in the RE. A Cochet-Bonnet esthesiometer revealed complete corneal anesthesia (<5 mm ie, >15.9 g/mm) in all quadrants in a scarred and neovascularized cornea. Twelve months after the procedure, the visual acuity of the RE was 20/80 and corneal sensitivity had increased to 40 mm, that is, 0.8 g/mm (superior quadrant), 35 mm, that is, 1 g/mm (inferior quadrant), 40 mm (temporal quadrant), 35 mm, that is, 1 g/mm (nasal quadrant), and 40 mm (centrally). We observed no clinical recurrence of herpes, and HSV was not detected in tears during the follow-up period., Conclusions: We report the first case of MICORNE, a novel surgical technique of corneal neurotization in a herpetic patient with NK. Despite the potential risk of viral recurrence, our patient showed dramatic improvement in corneal sensation and visual acuity.

Purpose: To describe the functional outcome, postoperative complications, and complication management of Descemet's membrane endothelial keratoplasty (DMEK) in corneal decompensation secondary to Herpes simplex eye disease (HED)., Methods: This retrospective interventional case series included 17 eyes that received DMEK for endothelial decompensation secondary to HED. Complete ophthalmological examination, including corrected-distance visual acuity (CDVA), anterior segment slit-lamp, and optical coherence tomography assessment, were performed preoperatively and postoperatively at regular follow-up intervals. Visual outcome and complication rates were compared with those of 72 consecutive eyes that received DMEK for Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) during the same period., Results: Mean follow-up time was 11.1 ± 5.9 months (range 6-27). CDVA improved from 1.16 ± 0.46 logMAR to 0.62 ± 0.44 logMAR (P = 0.001). Corneal pachymetry significantly decreased from 695 ± 53 μm at day 1 to 569 ± 88 μm at 2 months (P < 0.001). Postoperative complications occurred in 12 eyes, including primary graft failure (12%), endotheliitis (29%), corneal ulcers (35%), and cystoid macular edema (18%). Most complications occurred shortly after surgery, with a median delay of 2.5 months. In comparison, the complication rates for DMEK in FECD and PBK were significantly lower (no graft failure, P = 0.005; no endotheliitis, P < 0.001; no corneal ulcers, P < 0.001 and 3% cystoid macular edema, P = 0.046)., Conclusions: DMEK surgery significantly improved CDVA in patients with endothelial decompensation due to HED. The rate of postoperative complications was higher than for FECD and PBK. Close follow-up is mandatory and the rate of postoperative inflammatory events suggests that patients should be kept on high doses of oral valacyclovir.

Purpose: To evaluate corneal higher-order aberrations (HOAs) in eyes with corneal scars due to herpes simplex keratitis (HSK)., Methods: Forty-four eyes of 41 consecutive patients who were diagnosed with corneal scars due to HSK and 18 control eyes were included. HOAs of the anterior and posterior surfaces and the total cornea were analyzed using anterior segment optical coherence tomography. Corneal opacity grades were assigned on the basis of slit-lamp examinations., Results: HOAs within a 4-mm diameter were significantly larger in eyes with HSK (anterior surface, 1.01 ± 1.18 μm; posterior surface, 0.25 ± 0.24; total cornea, 1.00 ± 1.00) compared with controls (0.10 ± 0.02, 0.02 ± 0.00, and 0.09 ± 0.01, respectively; all P < 0.001). HOAs within a 6-mm diameter were significantly larger in eyes with HSK (anterior surface, 1.87 ± 1.75; posterior surface, 0.42 ± 0.44; total cornea, 1.85 ± 1.46) compared with controls (0.19 ± 0.04, 0.06 ± 0.01, and 0.17 ± 0.03, respectively; all, P < 0.001). The logarithm of the minimum angle of resolution (logMAR) decreased with the corneal opacity score (0.42 ± 0.61 in grade 1, 1.30 ± 0.96 in grade 2, and 1.58 ± 0.90 in grade 3). LogMAR was significantly correlated with HOAs (R = 0.65, P < 0.0001). HOAs of the posterior surface increased from 0.15 ± 0.15 in grade 1 to 0.37 ± 0.33 in grade 3 (P = 0.005), whereas there was no difference in HOAs of the anterior surface and the total cornea among the different corneal opacity grades., Conclusions: Increased HOAs of the anterior and posterior surfaces occur in eyes with corneal opacity due to HSK. Larger corneal HOAs are associated with poorer visual acuity.

Purpose: To evaluate the long-term outcomes of deep anterior lamellar keratoplasty for the management of deep stromal corneal opacities after herpes simplex keratitis (HSK) infection., Methods: Case records of patients who underwent deep anterior lamellar keratoplasty between January 2006 and June 2012 to treat HSK-related deep stromal corneal scars were retrospectively analyzed. The cases were divided into folds-on, folds-off, and no-folds groups based on the presence of stromal folds intraoperatively. The main outcome measures were best-corrected visual acuity, endothelial cell density, and complications., Results: A total of 89 patients (89 eyes; 54 men and 35 women; 47.1 ± 12.9 years old) were included. Based on intraoperative events, 48 eyes had no stromal folds, 27 eyes had folds that were centrally peeled off, and 14 eyes had folds that could not be peeled. The average follow-up period was 50.4 ± 12.7 months. The mean best-corrected visual acuity improved from 1.63 ± 60.52 logMAR preoperatively to 0.44 ± 0.31 logMAR at the last visit (P < 0.001). Mean postoperative endothelial cell density was 1738 ± 573 cells per square millimeter. Eight eyes experienced HSK recurrence, 3 eyes had an episode of stromal rejection, and 3 eyes developed corneal endothelial decompensation. Cases in the folds-off group had a significantly higher rate of Descemet membrane microperforations compared with the other groups., Conclusions: Deep anterior lamellar keratoplasty is a viable alternative for the management of HSK-related deep stromal opacity. Although posterior corneal folds can be relieved intraoperatively in some of these cases, folds near Descemet membrane should be left in situ because of the high risk of Descemet membrane perforation.

Purpose: To evaluate and compare the ocular surface condition in herpetic interstitial stromal keratitis and neurotrophic ulcer groups and their normal fellow eyes., Methods: In this observational, cross-sectional case-control study, 85 consecutive patients were included, including 56 cases of treated herpetic interstitial keratitis and 29 patients with neurotrophic ulcers. Fifty-six age- and sex-matched participants were also recruited from a normal population as the control group. We evaluated and scored the subjective and objective measures of dry eye for both eyes of all patients. Then, we compared the score of the groups with one another and also with the control group. The main outcome measures were the discomfort level, visual symptoms of dry eye, conjunctival injection, conjunctival staining, corneal staining, corneal tear signs of dry eye, meibomian gland dysfunction, tear break-up time, Schirmer test score with anesthesia, and tear osmolarity., Results: The normal fellow eye of the herpetic keratitis group had significantly higher discomfort levels (1.4 ± 0.9 vs. 1.3 ± 0.5, P = 0.003), visual symptoms (1.7 ± 0.8 vs. 1.3 ± 0.7, P = 0.002), tear break-up time (8.3 ± 3.2 vs. 12.1 ± 3.3 seconds, P = 0.003), Schirmer test scores (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.04), and tear osmolarity (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.003) in comparison with normal controls. The normal fellow eyes of the neurotrophic ulcer group had significantly worse values for discomfort level (1.9 ± 0.9 vs. 1.3 ± 0.5, P < 0.001), tear break-up time (7.9 ± 4 vs. 12.1 ± 3.3, P = 0.004), Schirmer test score (8.1 ± 3.9 vs. 12.9 ± 3, P = 0.005), and tear osmolarity (295 ± 9.2 vs. 292.7 ± 5.9, P = 0.02) compared with normal controls., Conclusions: Both eyes of patients with neurotrophic ulcer and interstitial herpetic keratitis have a significantly poorer ocular surface condition compared with that of normal controls.

Objective: To describe a novel surgical technique for the sealing of large corneal perforations., Method: Case report of a perforated, 3-mm, postherpetic, corneal ulcer. A single layer of amniotic membrane was sewn to the internal surface of the cornea. An absorbable fibrin sealant patch (TachoSil) was placed in the area of the perforation, and a folded double layer of amniotic membrane was finally sewn to the external face of the cornea., Result: Surgery without complications, leading to restoration of the anterior chamber and good subjective tolerance., Conclusion: The reported technique seems to represent a good alternative emergency procedure for the management of corneal perforations larger than 2 mm.

Purpose: According to our clinical observation, patients with quiescent herpes simplex virus (HSV) stromal keratitis often seem to present with signs of dry eye in the contralateral eye. Our goal was to compare dry eye signs and symptoms in both eyes of patients with quiescent HSV stromal keratitis with those of age- and sex-matched control subjects with healthy corneas., Methods: A case-control study with 24 subjects per group., Results: The average age of 10 men and 14 women in each group was 58 years. The HSV eye of cases was first compared with the contralateral eye with a healthy cornea. As expected, the HSV eye had a significantly lower corneal sensation threshold (P = 0.001); no significant difference was however found for Schirmer tests done with anesthesia (basal tear secretion) and without anesthesia, tear breakup time, mucus and debris in the tear film, and eyelid margin redness or swelling. Then, the HSV eye of cases was compared with the right eye of controls, whereas the healthy eye of cases was compared with the left eye of controls. Patients with unilateral quiescent HSV stromal keratitis had significantly lower bilateral Schirmer tests both with anesthesia (P = 0.001) and without anesthesia (P = 0.02). Dry eye symptoms of the healthy cornea of cases and those of controls did not differ significantly., Conclusions: Both eyes of patients with quiescent HSV stromal keratitis in our population were dry even if many patients with HSV stromal keratitis did not have symptoms in their fellow eye.

Purpose: To evaluate the success of cyanoacrylate tissue adhesive in the management of corneal perforations associated with herpetic keratitis., Methods: Case records of 46 patients with microbiologically proven herpetic keratitis associated with corneal perforations that were treated with corneal gluing were analyzed retrospectively in a tertiary care hospital. N-Butyl cyanoacrylate tissue adhesive and bandage contact lens were applied in addition to antiviral therapy. The main outcome measure was preservation of the structural integrity of the globe., Results: Glue application could heal corneal perforations in only 17 eyes (37%). Therapeutic keratoplasty had to be performed in 26 eyes (57%) because of failure of the glue. Fourteen eyes (31%) required multiple applications of tissue adhesive, and 2 eyes had to be eviscerated. Location of perforation, additional anterior chamber intervention, and use of prophylactic acyclovir therapy had no statistically significant effect on the overall final outcome., Conclusion: Corneal perforations associated with herpetic keratitis may not heal with glue application alone, and corneal transplantation surgery may be required to maintain the ocular structural integrity.

Purpose: To evaluate the success rate of treating persistent corneal epithelial defects using 50% autologous serum eyedrops., Methods: We reviewed the medical records of all patients seen at our institution from September 2004 to May 2007 who had persistent corneal epithelial defects that were nonresponsive to conventional medical treatment and that were treated with 50% autologous serum eyedrops. We also correlated the defect duration prior to initiation of serum therapy with rate of epithelial healing., Results: A total of 25 eyes of 25 patients failed conventional medical therapy for treatment of a persistent corneal epithelial defect and were treated with 50% autologous serum eyedrops every 2 hours while awake. All corneas were neurotrophic, with the etiologies being herpetic (11 eyes), postkeratoplasty (8 eyes), postkeratorefractive surgery (1 eyes), diabetic (1 eye), post-chemical burn (1 eye), and unknown (3 eyes). The median duration of the epithelial defects prior to initiation of autologous serum eyedrops was 13.9 weeks (range 0.29-52 weeks). After institution of autologous serum therapy, 23 of the 25 eyes healed in a mean time of 22.4 days. Seventeen eyes (68.0%) healed within 4 weeks (mean 1.7 weeks) of starting therapy with 50% autologous serum eyedrops. The number of days required for healing was associated with the length of time the defect was open prior to initiation of serum drops (r = 0.68, P < 0.001)., Conclusions: The use of 50% autologous serum eyedrops appears to be an efficacious medical treatment modality for persistent corneal epithelial defects that are recalcitrant to conventional medical therapy.

Purpose: To report a case of lichen planus in a patient with a history of herpes simplex virus keratitis., Methods: Case report., Results: A 60-year-old woman with chronic conjunctivitis and a history of herpes simplex virus keratitis was evaluated for irritation and a plaque on her right upper and lower eyelid palpebral conjunctivae. A surgical excision showed acanthosis and an underlying lichenoid infiltrate with a thickened basement membrane., Conclusion: Lichen planus of the conjunctiva can be present in the absence of cicatrization in a patient with chronic irritation of the conjunctiva.

Purpose: To study the microbiological and clinical profile of cases of microbial keratitis in patients with Down syndrome., Methods: A retrospective chart review of all patients with Down syndrome and microbial keratitis admitted to the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, between January 1997 and January 2007 was undertaken. Main parameters evaluated were clinical and microbiological profile and final outcome., Results: Of 18 patients included in this study, 11 were men and 7 were women, with mean age of 50 +/- 29 years (range 20-61 years). The most common associated ocular abnormality was eyelid diseases (94%) followed by atopic keratoconjunctivitis (44%). Positive microbiological cultures were obtained in 5 (28%) cases with Streptococcus pneumoniae being the most prevalent isolate. Ocular herpes was detected in 2 patients with polymerase chain reaction. Surgical intervention was required in 13 (72%) patients in the form of keratoplasty (n = 3) corneal gluing (n = 2), tarsorrhaphy (n = 5), botox injection (n = 1), and enucleation (n = 2)., Conclusions: Microbial keratitis in Down syndrome is associated with eyelid problems and ocular atopy, and due to failure of medical therapy alone, surgical intervention is required in majority of cases.

Purpose: To report a case of bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis resulting in corneal perforation in a patient with pityriasis rubra pilaris., Methods: Case report., Results: A 77-year-old female with pityriasis rubra pilaris was referred for a perforated corneal ulcer of the left eye. Cultures were positive in both eyes for Herpes simplex and in the left eye for Pseudomonas fluorescens and Staphylococcus aureus A microbiological cure was obtained with a combination of tectonic keratoplasty, fortified topical antibiotics, and systemic acyclovir., Conclusions: Pityriasis rubra pilaris is a rare, inflammatory dermatologic disease that may predispose patients to bilateral Herpes simplex keratitis, secondary bacterial superinfection, and a tendency toward rapid stromal ulceration with risk of perforation.

Purpose: To repair corneal perforation using human fibrin glue and determine its efficacy., Methods: A case series study was performed on corneal perforations up to 3 mm in diameter who were admitted in Farabi Eye Hospital. Age, visual acuity, presence and size of corneal thinning, corneal epithelial defect, size and depth of corneal infiltration, site and size of corneal perforation, corneal vascularization, anterior chamber depth, and reaction and the etiology of corneal perforation were recorded. Then, corneal perforation was sealed using FG and soft contact lens, and the patients were followed up for at least 3 months. Healing of the corneal perforation with adhesive was considered as a success (the primary outcome) and reported., Results: Of 18 patients, 8 were women and 10 men. The mean age of the patients was 52 +/- 25.7 years. The size of corneal perforations was 0.6-3 mm (mean = 1.88 mm). The etiologies of corneal perforation were postinfectious in 11 and noninfectious in 7. Fifteen (83.3%) eyes had successful healing of corneal perforation after 3 months. All the patients who were failed had corneal perforation larger than 2 mm in diameter. The success rate was higher in corneal perforation

Purpose: To report an 81-year-old woman with corneal neovascularization secondary to herpetic stromal keratitis treated with subconjunctival bevacizumab and to discuss the role of this novel antiangiogenic treatment., Methods: Case report and review of medical literature., Results: A dramatic regression of corneal vessels was observed 1 week after the injection. After a 3-month follow-up, there was no recurrence of corneal revascularization., Conclusions: Bevacizumab may be a valid complementary treatment in patients with corneal neovascularization caused by herpetic stromal keratitis.

Purpose: To report a case of Alport syndrome with recurrent herpes simplex virus (HSV) keratitis., Methods: Case report and review of the literature., Results: A 29-year-old man with Alport syndrome suffered from 4 consecutive episodes of HSV keratitis within 2 years. A type IV collagen defect in basement membranes plays an important role in the pathogenesis of Alport syndrome. The relationship between HSV keratitis and Alport syndrome is discussed. After remission from HSV keratitis, the patient underwent bilateral phacoemulsification and posterior-chamber intraocular lens implantation for anterior lenticonus and an anterior polar cataract. After surgery, the uncorrected visual acuity was 20/20 in both eyes., Conclusions: We assume that the underlying basement membrane defects in Alport syndrome may account for the recurrent episodes of HSV keratitis in this patient. In addition, phacoemulsification and posterior-chamber intraocular lens implantation, rather than correction of refractive errors, provide a safe and efficient therapeutic choice for the management of anterior lenticonus, with or without associated cataract in patients with Alport syndrome.

Objective: To describe the changes in corneal thickness determined by ultrasonic pachymetry during follow-up of herpes simplex virus disciform corneal edema., Methods: Thirty-five patients with herpetic keratitis underwent slit-lamp biomicroscopy and ultrasonic pachymetry. Measurements during follow-up and at clinical resolution of corneal inflammation were compared with the initial corneal thickness., Results: Corneal thickness of disciform stromal keratitis decreased 15% (95% confidence interval 10% to 20%) during follow-up, and 65% (95% confidence interval 43% to 88%) of this decrease occurred during the first 2 weeks. Increased central corneal thickness measured by pachymetry was associated with biomicroscopic detection of corneal edema (P = 0.03)., Conclusions: Corneal pachymetry supplements clinical assessment of herpetic disciform edema.

Purpose: This study was conducted to evaluate the effect of topical medroxyprogesterone (MPG) following KPro implantation in human subjects in whom donor tissue grafts had been contraindicated by high risk of failure., Methods: Outcomes of implantation of the Chirila KPro, now known as AlphaCor, were reviewed with respect to postoperative MPG therapy. Ten of 45 (22%) patients had received MPG for a period of 12 months, while 35/45 (78%) had not. MPG treatment was halted because the drug is not approved as an adjunctive treatment of KPro patients. The main outcome measures were the incidence and timing of corneal stromal melting and visual acuity., Results: Of those untreated with MPG, 34% developed a melt (mean follow-up 9.7 months), whereas of those who received MPG, 60% developed a melt (mean follow-up 28.4 months). However, mean time to melt onset for untreated cases was 8.8 months, whereas mean time to melt onset for treated cases was 23.2 months. There is a statistically significant association between time to melt onset, where melts occurred, and MPG therapy (chi2 = 0.001). In both groups, melts were strongly associated with a history of ocular HSV, which represented 17.1% of untreated and 20% of treated cases and is now considered a contraindication for AlphaCor. Preoperative visual acuities were in the range Perception Light (PL)-Count Fingers (CF) in all cases, whereas mean best postoperative best corrected visual acuity was 20/200 (range PL-20/30) in untreated cases and was 20/120 [range Hand Movements (HM)-20/30)] in MPG-treated cases., Conclusions: Although MPG may not influence the underlying incidence of melt-related complications, which are likely to be associated with other risk factors especially HSV, it may have a protective effect with regard to melt onset and severity. Controlled studies would assist evaluation of its use in this indication.

Purpose: To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in two patients., Methods: Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months., Results: Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases., Conclusions: PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required.

Purpose: To present a cluster of four patients with primary graft failure (PGF) who consecutively underwent a penetrating keratoplasty (PKP) during a period of 17 days in one institution. PKP was performed for reasons unrelated to herpes simplex infection. Herpes simplex virus type 1 (HSV-1) is presented as the possible cause of these PGFs., Methods: Viral culture of conjunctival swabs and of a bandage contact lens was performed on VERO, MRC-5, and Hep-2 cells. The four patients underwent subsequent regrafting. Polymerase chain reaction (PCR) for HSV-1 was carried out on aqueous humor and on a sample of iris and cornea with primers. Aqueous humor specimens were pretreated by boiling, and a qiagen extraction was performed according to the instructions of the manufacturer on biopsies of iris and cornea. Immunohistopathology was performed with polyclonal antibodies directed against HSV-1 and -2., Results: Culture of a conjunctival swab in three patients and culture of a bandage contact lens in the fourth patient were positive for HSV-1. In three of the four patients, PCR was positive for HSV-1 on aqueous humor and corneal graft tissue. PCR on iris tissue was positive in all patients. In three patients, culture for HSV-1 of aqueous humor and of iris tissue could not be carried out because of insufficient sample. Viral culture of the iris tissue in one patient and of the corneal graft in the four patients were negative. Immunohistopathologic examination was positive for HSV-1 in three cases., Conclusion: These case reports strongly support the hypothesis that HSV-1 can be the cause of PGF.

Two patients with previous corneal transplants developed unusual rejection-like episodes of the grafted cornea. Both had a migrating line of keratic precipitates and stromal edema involving both the donor and recipient corneas. Intensive steroid treatment attained little effect, but oral acyclovir treatment dramatically suppressed the disease process. The facts suggest that a virus-related immune mechanism against both the donor and recipient endothelia, rather than simple allograft rejection, may have been responsible for the clinical presentations. Oral acyclovir therapy might be considered in patients with steroid-nonresponsive corneal endotheliitis mimicking allograft rejection.

A neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used in the thermal mode to coagulate blood vessels in a patient with a vascularized corneal leukoma in an attempt to reduce neovascularization before penetrating keratoplasty. Occlusion of the feeder artery at the periphery was followed by a large stromal hemorrhage. A successful keratoplasty was performed 2 days later.