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Updated: Aug 9, 2026
Ex Vivo Organotypic Corneal Model of Acute Epithelial Herpes Simplex Virus Type I Infection
Published on: November 3, 2012
Recurrent herpes simplex keratitis with concurrent epithelial and stromal involvement. Immunohistochemical and
L M Holbach1, R L Font, K R Wilhelmus
1Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030.
Insights
Recurrent herpetic keratitis can lead to subclinical stromal infection in corneal grafts. This study found herpes simplex virus in stromal keratocytes near epithelial dendrites, indicating deeper viral spread.
Area of Science:
- Ophthalmology
- Virology
- Histopathology
Background:
- Recurrent herpetic keratitis poses a risk for corneal graft failure.
- Corneal transplantation is a treatment for persistent graft dysfunction.
Observation:
- A corneal button from a patient with recurrent herpetic keratitis showed an epithelial dendrite with Cowdry type A inclusions.
- Herpes simplex virus (HSV) antigens and particles were detected in epithelial cells and stromal keratocytes.
- Subclinical stromal infection was evidenced by HSV presence in keratocytes distant from the epithelial defect.
Findings:
- The study identified HSV in stromal keratocytes, suggesting subclinical stromal involvement.
- Infected epithelial cells extended approximately 200 microns on either side of the epithelial dendrite.
- Electron microscopy confirmed herpesvirus particles within both epithelial and stromal cells.
Implications:
- Recurrent epithelial dendrites in corneal grafts may indicate underlying subclinical stromal viral infection.
- This finding has implications for understanding HSV recurrence patterns and graft management.
- Further research may explore the clinical significance of subclinical stromal HSV infection in transplantation.
Abstract:
A 65-year-old man with recurrent herpetic keratitis underwent corneal transplantation for persistent nonimmunologic graft failure. Histopathologic examination of the corneal button revealed an epithelial dendrite containing Cowdry type A inclusion bodies, moderate stromal edema, and a retrocorneal fibrous membrane. Immunohistochemical studies demonstrated herpes simplex virus antigens in epithelial cells bordering the dendritic defect and in stromal keratocytes. The mean width of corneal epithelium displaying herpes simplex virus-positive epithelial cells on either side of the dendritic defect measured 200 +/- 46 microns. By electron microscopy, herpesvirus particles were identified in epithelial cells lining the dendrite as well as in stromal keratocytes. Infected keratocytes were scattered throughout the stroma but were not observed subjacent to the epithelial dendrite. This study demonstrates that a recurrent epithelial dendrite can be associated with subclinical stromal infection of the graft.
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