Adverse Occurrence type:
Alerting signals, symptoms, evidence of occurrence:
Epithelial defect and anterior uveitis consistent with herpetic infection. Corneal lesions may include typical dendritic or geographic ulcers, as well as stromal scars. These lesions cause opacification of the cornea and blindness. Detection of HSV DNA in the cornea by polymerase chain reaction (PCR) assay or in situ hybridization methods. Detection of HSV antigens by immunofluorescence assays or detection of virus by culture from corneal scrapings. Electron microscopy exhibits large numbers of herpes virus particles, located in and around keratocytes.
Demonstration of imputability or root cause:
Positive HSV-1 DNA PCR testing from both the corneoscleral rim and the patient’s serum post transplant when no HSV-specific IgM or IgG antibodies were present in recipient’s serum before surgery. Genotyping of donor and recipient HSV strains using PCR-based DNA fingerprinting.
[How "safe" is corneal transplantation? A contribution on the risk of HSV-transmission due to corneal transplantation]
Ultrastructural demonstration of replicative herpes simplex virus type 1 transmission through corneal graft