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  • Herpes simplex virus keratitis: histopathologic inflammation and corneal allograft rejection
  • Shtein RM; Garcia DD; Musch DC; Elner VM
  • Ophthalmology 2009[Jul]; 116 (7): 1301-5
  • OBJECTIVE: To identify whether histopathologic and immunoassay biomarkers of inflammation are predictive for allograft rejection after penetrating keratoplasty (PKP) for herpes simplex virus (HSV) keratitis. DESIGN: Retrospective, interventional case series with prospective component of pathologic evaluation of frozen tissue. PARTICIPANTS: Sixty-two consecutive patients with HSV keratitis who underwent PKP. METHODS: A chart review and histopathologic examination of the excised host corneal button was performed to identify associations between clinical data and histopathologic presence of inflammation. Enzyme-linked immunosorbent assay for interleukin (IL)-8 and monocyte chemotactic protein-1 (MCP-1) chemokines and immunohistochemical staining for human leukocyte antigen (HLA)-DR and intercellular adhesion molecule-1 (ICAM-1) antigens was also performed in inflamed and noninflamed specimens. MAIN OUTCOME MEASURES: To determine whether the presence of subclinical inflammation at the time of PKP predicts allograft rejection. RESULTS: Although 81% of patients had clinically quiescent disease, histopathology revealed that 74% had active corneal inflammation, a finding that was associated with the presence of clinical neovascularization (P = 0.01). Allograft rejections were experienced by 34% of the patients in this cohort. The histopathologic presence of inflammation was a risk factor for allograft rejection (P = 0.02). Corneal specimens demonstrating inflammation had significantly increased IL-8 (P = 0.0005) and MCP-1 (P = 0.003) levels, and greater immunoreactivity for HLA-DR and ICAM-1 when compared with specimens without inflammation. Treatment with IL-10 ex vivo significantly inhibited IL-8 (P = 0.006), and MCP-1 (P = 0.01) chemokines, and qualitatively substantially reduced HLA-DR, but not ICAM-1, expression. CONCLUSIONS: Histopathologic inflammation is a risk factor for corneal allograft rejection.
  • |*Keratoplasty, Penetrating[MESH]
  • |Adolescent[MESH]
  • |Adult[MESH]
  • |Aged[MESH]
  • |Aged, 80 and over[MESH]
  • |Biomarkers/metabolism[MESH]
  • |Chemokine CCL2/metabolism[MESH]
  • |Chemokines/metabolism[MESH]
  • |Child[MESH]
  • |Child, Preschool[MESH]
  • |Cornea/metabolism/*pathology[MESH]
  • |Enzyme-Linked Immunosorbent Assay[MESH]
  • |Female[MESH]
  • |Graft Rejection/*diagnosis/etiology/metabolism[MESH]
  • |HLA-DR Antigens/metabolism[MESH]
  • |Humans[MESH]
  • |Inflammation/*diagnosis/metabolism[MESH]
  • |Intercellular Adhesion Molecule-1/metabolism[MESH]
  • |Interleukin-8/metabolism[MESH]
  • |Keratitis, Herpetic/metabolism/*surgery[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Retrospective Studies[MESH]
  • |Risk Factors[MESH]
  • |Transplantation, Homologous[MESH]
  • |Young Adult[MESH]

  • *{{pmid19576497}}
    *<b>[ Herpes simplex virus keratitis: histopathologic inflammation and corneal allograft rejection ]</b> Ophthalmology 2009; 116(7) ; 1301-5 Shtein RM; Garcia DD; Musch DC; Elner VM


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    1301 7.116 2009