97th DOG Annual Meeting 1999



A. Liekfeld, C. Jaeckel, U. Pleyer, C. Hartmann

Purpose: Herpetic keratitis is a common indication for corneal transplantation. Especially in this patient group there is a relatively high risk of graft failure, partly because of viral recurrence. It can be difficult to distinguish clinically stromal herpetic recurrence from early endothelial allograft rejection. Also a perioperative observation of viral activity seems sensible because of therapeutic consequences. For those reasons we use aqueous humor analysis in certain corneal transplant patients to determine intraocular antibody production. The aim of this study was to evaluate the diagnostic value of such an aqueous humor analysis.

Material and Methods: 21 samples of aqueous humor were obtained from 18 patients. In 11 patients the samples were obtained only during corneal transplantation, in 4 patients only after transplantation and in 3 patients intraoperatively as well as postoperatively. In all samples antibodies against herpes simplex virus (HSV) were measured, in most samples (19/21) antibodies against varizella zoster virus (VZV) and in some samples (3/21) antibodies against cytomegalovirus. We used a modified micro-ELISA technique to detect intraocular IgG production.

Results: In 12 samples (57,1%) we determined antibodies against HSV, in 6 samples (28,6%) against HSV and VZV, in 1 sample (4,8%) against VZV. 2 samples (9,5%) were negative for all tested antibodies.

Conclusion: The results of aqueous humor analysis lead to a specific local or systemic antiviral therapy perioperatively or in case of postoperative recurrence of herpetic keratitis in most patients. Some patients could be saved from long-term treatment with antiviral agents because of negative results in aqueous humor analysis.

Dept. of Ophthalmology, Charité, Campus Virchow-Klinikum, D-13353 Berlin