title: Recurrent cytomegalovirus corneal endotheliitis after penetrating keratoplasty.
abstract: OBJECTIVE
  To report a case of recurrent cytomegalovirus (CMV) corneal endotheliitis after penetrating keratoplasty.
  
  
  METHODS
  Penetrating keratoplasty (PK) was performed in a 49-year-old man with bullous keratopathy. Pigmented keratic precipitates (KPs) were found in the corneal endothelium of the graft 13 days after surgery, with the subsequent appearance of coin-shaped lesions. Confocal microscopy was performed on the corneal endothelium. Aqueous humor was analyzed for viral DNA by polymerase chain reaction (PCR).
  
  
  RESULTS
  CMV DNA was detected from the excised corneal button, and aqueous humor revealed positive results for CMV and HSV1 by PCR. Confocal microscopy showed large corneal endothelial cells, consistent with the typical owl's eye morphology of CMV endotheliitis. After systemic ganciclovir was administered, the pigmented KPs and coin-shaped lesions gradually decreased.
  
  
  CONCLUSIONS
  Stress from surgery and corticosteroid usage can revitalize CMV activity. PCR and confocal microscopy are valuable for the diagnosis of CMV corneal endotheliitis.
authors.affiliation: Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan.
authors.forename: Shih-Chien
authors.initials: SC
authors.lastname: Wang
authors.forename: I-Lun
authors.initials: IL
authors.lastname: Tsai
authors.forename: Hsiao-Cheng
authors.initials: HC
authors.lastname: Lin
authors.forename: Li-Lin
authors.initials: LL
authors.lastname: Kuo
authors.forename: Ching-Yao
authors.initials: CY
authors.lastname: Tsai
authors.forename: Shiow-Wen
authors.initials: SW
authors.lastname: Liou
mesh_terms: D001082:Aqueous Humor / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D004728:Endothelium, Corneal / Q000473:pathology* / Q000821:virology; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D041623:Tomography, Optical Coherence
chemical_list: D004279:DNA, Viral