Cytomegalovirus infection is not a major cause of corneal graft failure in the United Kingdom

• Published in: Eye (London) 2019-05, Vol.33 (5), p.833-837
• Main Authors: da Costa Paula, Claudia A., Gore, Daniel M., Shah, Khilan, Kuit, Geert, Angunawela, Romesh I., Barnett, James P., Tuft, Stephen J.
• Format: Article
• Language: English
• Subjects: 45/77; 692/308/174; 692/699/3161/3163; Allografts; Cornea; Corneal Transplantation; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus Infections - virology; Deoxyribonucleic acid; DNA; DNA, Viral - analysis; Endothelium, Corneal - virology; Eye Infections, Viral - virology; Female; Graft rejection; Graft Rejection - virology; Grafts; Herpes simplex; Humans; Hybridization; In Situ Hybridization; Keratitis - virology; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Paraffin; Paraffin Embedding; Pharmaceutical Sciences/Technology; Polymerase Chain Reaction; Retrospective Studies; Risk Factors; Seroepidemiologic Studies; Serology; Surgery; Surgical Oncology; Tissue Fixation; United Kingdom; Varicella
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-018-0331-9

Background Cytomegalovirus (CMV) endotheliitis is a significant cause for acute corneal allograft rejection in East Asian populations, where there is a high CMV seroprevalence. To determine how frequently CMV is associated with corneal graft failure in the UK, we looked for the presence of CMV DNA in grafts that had failed and had been removed at repeat keratoplasty. We also looked for CMV DNA in corneal rims discarded after corneal transplantation. Methods In this retrospective study, we identified 54 cases of corneal graft failure following endothelial rejection and 38 control grafts that had failed without a history of endothelial rejection. For these groups archived formalin-fixed paraffin-embedded (FFPE) tissue samples were retrieved. We also prospectively examined 80 non-fixed cornea rims following transplantation surgery. In all samples nested quantitative PCR was used to identify CMV, herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA. We also used in situ hybridisation to examine for CMV DNA in the FFPE samples. Results No CMV or VZV DNA was detected in any of the archived case or control FFPE tissues. One corneal rim from the control group was positive for HSV. In situ hybridisation for CMV was negative for CMV in all FFPE samples. No CMV, VZV or HSV DNA was detected in the donor corneal rim samples. Conclusion CMV DNA was not identified in excised failed corneal tissue or from tissue prior to transplantation. We infer that CMV infection is not a significant factor risk for corneal graft failure in the United Kingdom.