NEW MICROBIOLOGICA, 33, 171-174, 2010 Persistent epithelial defect after penetrating keratoplasty caused by adenoviral infectious keratitis Federico Ricci 1 , Filippo Missiroli 1 , Marco Ciotti 2 , Carlo Federico Perno 2,3 , Luciano Cerulli 1 1 Department of Ophthalmology, University of Rome Tor Vergata, Rome, Italy; 2 Laboratory of Molecular Virology, Foundation Polyclinic Tor Vergata, Rome Italy; 3 Virology, Department of Experimental Medicine and Biochemical Sciences INTRODUCTION Epithelial defects frequently occur in the donor cornea in the early and, less commonly, in the late postoperative period after penetrating ker- atoplasty (PKP). Epithelial defects in the early postoperative period may result from exposure before death, trauma during tissue retrieval, loss of the donor epithelium during storage or the ac- cidental, or purposeful removal of graft epitheli- um during surgery. Contributing factors for post- operative epithelial defects include ocular sur- face disorders, such as aqueous deficiency dry eye, exposure secondary to eyelid abnormality, ocular cicatrizing disorders, limbal stem cell de- ficiency and donor-recipient misalignment re- sulting in dry areas (Mannis et al., 1997). When epithelial defects do not heal within the first 10 to 14 days with conventional treatment they are called persistent epithelial defects (PED) and Corresponding author Dr. Marco Ciotti Laboratory of Molecular Virology Foundation Polyclinic Tor Vergata Viale Oxford, 81 - 00133 Rome, Italy E-mail: marco.ciotti@ptvonline.it they are considered one of the most common early postoperative complications after PKP (Mannis et al., 2006). Early postoperative epithelial defects usually re- spond promptly to supplemental lubrication, punctum plugs, serum eye drops, bandage con- tact lens and less often may require a tarsorrha- phy. Nonresponsive epithelial defects may also result from herpes simplex virus (HSV) infection, even in patients without a clinical history of HSV (Beyer et al., 1990; Remeijer et al., 1997). We describe a case of persistent epithelial defect after an uncomplicated PKP for keratoconus in a young patient (with no limbal or conjunctival ep- ithelial abnormalities) in which PCR analysis of conjunctival scraping demonstrated the presence of adenoviral infection. CASE REPORT A 42 year-old male with keratoconus presented with visually limiting irregular astigmatism in his right eye with a best-corrected visual acuity of 2.0 LogMAR and with pinhole visual acuity of 0.4 LogMAR. An uncomplicated penetrating kerato- plasty (PKP) was performed with an 8.50 mm or- A causal role of herpes simplex infection in persistent epithelial defect following penetrating keratoplasty (PKP) has been doc- umented in the past. Instead, not much information is available on the role of adenovirus infection in delayed epithelization following PKP. Here, we describe a case of persistent epithelial defect due to adenoviral infection keratitis confirmed by PCR analysis. Adenovirus keratitis can be an unusual cause of delayed epithelization after PKP. KEY WORDS: Adenovirus, Persistent epithelial defect, Penetrating keratoplasty, PCR (polymerase chain reaction) SUMMARY Received August 4, 2009 Accepted September 30, 2009