DNA of cytomegalovirus detected by PCR in aqueous of patient with corneal endotheliitis after penetrating keratoplasty.
OBJECTIVE
Corneal endotheliitis often leads to severe endothelial dysfunction and can be caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and other viruses (eg, the mumps virus). We report a case of corneal endotheliitis caused by cytomegalovirus (CMV) that developed after a penetrating keratoplasty.


METHODS
A complete ophthalmologic examination was performed on a patient with corneal endotheliitis that developed after a penetrating keratoplasty. To determine the cause of the endotheliitis, polymerase chain reaction (PCR) was used to amplify the DNA of HSV, VZV, and CMV in samples of the aqueous humor.


RESULTS
Slit-lamp biomicroscopy showed a moderate stromal edema in the upper temporal part of the transplanted cornea along with keratic precipitates (KPs) arranged in a coin-shaped pattern. Repeated treatments with steroids and acyclovir were only temporarily successful. PCR detected the DNA of CMV in an aqueous sample, and the treatment was switched to topical and systemic application of ganciclovir. This resulted in the disappearance of the KPs and resolution of the stromal edema within 2 weeks.


CONCLUSIONS
From the PCR results and the favorable response to ganciclovir, the corneal endotheliitis was most likely caused by cytomegalovirus in this case.
Suzuki
Takashi
T
Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan. s-t-ishizuchi@orion.ocn.ne.jp
Hara
Yuko
Y
Uno
Toshihiko
T
Ohashi
Yuichi
Y
D000368:Aged; 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 / Q000821:virology*; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D015948:Keratoplasty, Penetrating; D008297:Male; D016133:Polymerase Chain Reaction
D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir