title: Cytomegalovirus keratitis after penetrating keratoplasty.
abstract: We report the development of cytomegalovirus (CMV) keratitis in the penetrating keratoplasty of a 59-year-old human immunodeficiency virus-negative woman after uncomplicated corneal transplantation. Immunosuppression with topical cyclosporine A 2% in corn oil and topical prednisolone acetate 1% suspension was used postoperatively. The 15-month postoperative course was complicated by multiple episodes of endothelial rejection, medically controlled elevated intraocular pressure, polymicrobial bacterial (coagulase-negative staphlococcus and alpha-hemolytic streptococcus) keratitis, and endothelial plaque formation with associated hypopyon and epithelial defect. The graft failed and penetrating keratoplasty was repeated. Cytomegalovirus infection of superficial keratocytes in a region of scarring was identified in histological sections stained with hematoxylin and eosin and confirmed using mouse monoclonal anti-cytomegalovirus antibodies. Excision of the diseased corneal button with no additional treatment appears to have been curative. Low-grade keratitis was the only manifestation of the CMV infection, and it has not recurred 6 months postoperatively.
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Wehrly
authors.forename: F J
authors.initials: FJ
authors.lastname: Manning
authors.forename: A D
authors.initials: AD
authors.lastname: Proia
authors.forename: J L
authors.initials: JL
authors.lastname: Burchette
authors.forename: G N
authors.initials: GN
authors.lastname: Foulks
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal; D000956:Antigens, Viral / Q000032:analysis; D003315:Cornea / Q000473:pathology / Q000601:surgery / Q000821:virology; D003319:Corneal Stroma / Q000473:pathology / Q000821:virology; D016572:Cyclosporine / Q000008:administration & dosage; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000473:pathology; D015828:Eye Infections, Viral / Q000209:etiology* / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007124:Immunoenzyme Techniques; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007634:Keratitis / Q000473:pathology / Q000821:virology*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011239:Prednisolone / Q000008:administration & dosage; D012086:Reoperation
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000956:Antigens, Viral; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D016572:Cyclosporine; D011239:Prednisolone