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.
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