Aqueous Humor Herpes Simplex Virus Polymerase Chain Reaction Testing In Eyes Undergoing Dsaek For Endothelial Decompensation Of Indeterminate Etiology

To report the outcomes of patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for endothelial decompensation of indeterminate etiology whose aqueous humor polymerase chain reaction (PCR) tested positive for HSV-DNA.

Ospedali Privati Forlì, "Villa Igea", Forlì, Italy

All eyes with endothelial decompensation with a history of uneventful cataract surgery, no known history of herpetic disease and normal endothelial cell count and morphology in the contralateral eye were included. During primary DSAEK, aqueous humor samples were collected for HSV DNA PCR testing. Occurrence of immunological rejection and/or herpetic eye disease, best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss (ECL) were evaluated. 

Of 15 consecutive eyes of 15 patients, five (33%) eyes tested positive for HSV DNA. One of five eyes (20%) developed herpetic epithelial keratitis which resolved with combined topical and systemic antiviral therapy. An additional two eyes developed immunologic rejection and/or herpetic recurrence, of which one case required repeat DSAEK surgery. At one year follow-up, average logMAR BSCVA significantly improved from 1.74±0.13 to 0.51±0.47 (P = 0.008), whereas mean ECL was 24 ± 15%.

HSV DNA PCR testing of aqueous humor samples collected during DSAEK may be recommended in cases of endothelial decompensation of indeterminate etiology. Intensive high-dose antiviral prophylaxis may be required in cases with HSV-positive PCR to reduce the risk of immune rejection, herpetic recurrence and subsequent graft failure.