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A total of 307 aqueous humor (AH) samples from 235 Patients and 244 eyes who underwent penetrating keratoplasty or Descemet membrane endothelial keratoplasty or had a diagnostic AH aspiration due to clinical AGR between 2019 and 2023 were tested for DNA of herpes simplex virus (HSV), varicella\u2010zoster virus (VZV), cytomegalovirus (CMV), and Epstein\u2010Barr virus (EBV). PCR test results were compared between the two groups (with\/without AGR). Another sub\u2010analysis examined the results of patients without a history of herpetic keratitis. A total of 8% of eyes with clinical AGR (9\/108) had a positive PCR result for one of the herpesviruses (HSV:3, CMV:3, EBV:2, VZV:1). All patients in the group without AGR had negative PCR results for all previous viruses (0\/136). The difference was statistically significant (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The sub\u2010analysis of eyes without a history of herpetic keratitis also revealed significantly more positive herpes PCR results (7\/87) in eyes with AGR than in eyes without AGR (0\/42, <jats:italic>p<\/jats:italic>\u2009=\u20090.005). Clinical AGR after keratoplasty shows a significant correlation to viral replication. Herpetic infection and AGR could occur simultaneously and act synergistically. Timely differentiation between active herpetic infection and\/or AGR is pivotal for proper treatment and graft preservation.<\/jats:p>","DOI":"10.1002\/jmv.29538","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T06:19:53Z","timestamp":1710915593000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["PCR testing for herpesviruses in aqueous humor samples from patients with and without clinical corneal endothelial graft rejection"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8642-0222","authenticated-orcid":false,"given":"Yaser","family":"Abu Dail","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Saarland University Medical Center Homburg Saarland Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loay","family":"Daas","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology 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