Cytomegalovirus as an etiologic factor in corneal endotheliitis.
OBJECTIVE
To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan.


METHODS
Retrospective, consecutive, multicenter case series.


METHODS
Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye.


METHODS
Retrospective review of the clinical manifestations and responses to antiviral treatment.


METHODS
Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy.


RESULTS
The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy.


CONCLUSIONS
Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. nkoizumi@ophth.kpu-m.ac.jp
Noriko
N
Koizumi
Takashi
T
Suzuki
Toshihiko
T
Uno
Hidemi
H
Chihara
Atsushi
A
Shiraishi
Yuko
Y
Hara
Tsutomu
T
Inatomi
Chie
C
Sotozono
Satoshi
S
Kawasaki
Kenta
K
Yamasaki
Chikako
C
Mochida
Yuichi
Y
Ohashi
Shigeru
S
Kinoshita
D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D002452:Cell Count; 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 / Q000473:pathology / Q000821:virology*; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000998:Antiviral Agents; D004279:DNA, Viral; D014633:Valine; D000077483:Valacyclovir; D015774:Ganciclovir; D000212:Acyclovir