Corneal endotheliitis associated with evidence of cytomegalovirus infection.
OBJECTIVE
To describe the clinical presentation of cytomegalovirus (CMV) corneal endotheliitis in human immunodeficiency virus (HIV)-negative patients.


METHODS
Retrospective interventional case series.


METHODS
Twelve consecutive patients with corneal endotheliitis diagnosed between 2002 and 2005.


METHODS
Aqueous of eyes with corneal endotheliitis was analyzed for viral DNA by polymerase chain reaction (PCR), and patient records were reviewed for demographic data, medical and ocular history, best-corrected Snellen visual acuity, intraocular pressure (IOP), anterior and posterior segment findings, laboratory workup, diagnosis, and treatment.


METHODS
Presence of CMV DNA.


RESULTS
Corneal endotheliitis was seen in 12 eyes of 10 patients during the study period. There were 8 men and 2 women, and all were Chinese. Their mean age was 49 years (range, 25-61 years). The corneal involvement ranged from small areas of focal endotheliitis to diffuse bullous keratopathy. The keratic precipitates had a variable appearance. There was only mild anterior chamber inflammation with no posterior synechiae. Two thirds of eyes had diffuse iris atrophy. All the eyes had elevated IOP. Eleven of the 12 eyes were positive for CMV DNA. None of the patients were positive for HIV. All patients had received local or systemic immunosuppression, or both, before corneal endotheliitis developed. Ten eyes of 8 patients were treated with systemic antiviral therapy. After treatment, the endotheliitis resolved completely in 7 eyes, and 3 eyes had significant improvement in corneal translucency. The IOP was normal, with no medications in all but 1 eye. Repeat PCR analysis in all the treated eyes was negative for CMV DNA.


CONCLUSIONS
Cytomegalovirus infection is an important cause of corneal endotheliitis in our patients, and appropriate antiviral therapy may prevent more ocular damage.
Chee
Soon-Phaik
SP
Singapore National Eye Centre, Singapore. chee.soon.phaik@snec.com.sg
Bacsal
Kristine
K
Jap
Aliza
A
Se-Thoe
Su-Yun
SY
Cheng
Ching Li
CL
Tan
Ban Hock
BH
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D004728:Endothelium, Corneal / Q000187:drug effects / Q000473:pathology / Q000821:virology*; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007429:Intraocular Pressure; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D014792:Visual Acuity
D000998:Antiviral Agents; D004279:DNA, Viral