Although corneal allograft rejection after penetrating keratoplasty responds to corticosteroids, in some edematous grafts, herpes simplex virus, varicella-zoster virus, or cytomegalovirus causes corneal endotheliitis refractory to steroids and leads to graft failure without appropriate antiviral therapy.1 However, other cases with idiopathic corneal endotheliitis refractory to steroids remain to be studied. Human herpesvirus 8 (HHV-8) is associated with neoplastic diseases.2,3 We report graft failure after penetrating keratoplasty, with aqueous humor positive for HHV-8 DNA by real-time polymerase chain reaction.
Figure. Relationship between the therapeutic outcome with allograft rejection therapy and human herpesvirus 8 (HHV-8) copy number. A, Slitlamp photograph shows localized corneal edema on a corneal graft with keratic precipitates (arrows) and severe injection before treatment (day 0). B, Slitlamp photograph shows that the corneal edema gradually progressed and resulted in total bullous keratopathy 4 weeks after treatment (day 28). C, Although allograft rejection therapy continued, the corneal edema progressed gradually to total bullous keratopathy resulting in graft failure, and the HHV-8 copy number had not decreased by 4 weeks after treatment. When the HHV-8 copy number reached an undetectable level, the visual acuity and the clinical appearance of the bullous keratopathy 3 months after treatment (day 90) did not improve. Arrows indicate administration of intravenous methylprednisolone hemisuccinate, 125 mg; BCVA, best-corrected visual acuity.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.