PURPOSE: To report the value of polymerase chain reaction in the diagnosis of a worsening corneal ulcer. METHODS: A 6-year-old boy underwent an emergent penetrating keratoplasty for a corneal ulcer that continued to worsen despite intensive antibiotic therapy. RESULTS: Examination of the corneal specimen by polymerase chain reaction was positive for varicella- zoster virus but negative for herpes simplex. Based on polymerase chain reaction studies, we diagnosed primary varicella-zoster keratitis with corneal perforation. Electron microscopy showed herpetic virus particles in the cornea. CONCLUSIONS: Polymerase chain reaction analysis of curheal buttons at the time of penetrating keratoplasty may benefit patients with undiagnosed recalcitrant corneal ulcers.
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