Use of a corneal impression membrane for the detection of Herpes Simplex Virus type-1

Purpose: To investigate the use of a corneal impression membrane (CIM) for the detection of Herpes Simplex Virus type 1 (HSV-1) in suspected Herpes Simplex Keratitis (HSK). Materials and Methods: In the laboratory study, swabs and CIMs made from polytetrafluoroethylene were spiked with different concentrations of HSV-1. DNA was extracted and real time PCR undertaken using 2 sets of primers. In the clinical study consecutive patients presenting with suspected HSK were included. For each patient, samples were collected from corneal lesions with a swab and a CIM in random order. Clinical details were collected using a standardised clinical form and patients were categorized into probable, presumed and possible HSK. Results: There was no difference in the performance of both primer sets for all HSV-1 dilutions (p=0.83) or between a CIM and a swab (p=0.18). 110 patients were included. Seventy-three patients (66.4%) had probable, 20 patients (18.2%) presumed, and 17 patients (15.5%) possible HSV-1 keratitis. The HSV-1 detection rate was significantly higher using a CIM (40/110, 36.4%) than a swab (28/110, 25.5%) (p=0.004). In the probable HSV keratitis group, the detection rate using a CIM was 43.8% compared to 27.4% for a swab (p=0.004). The Cp values obtained for the conjunctival swabs were higher than those obtained for the CIMs (p<0.001). Conclusions: In suspected HSK, a CIM is a useful alternative to a swab and more likely to detect the presence of HSV-1.