Recurrent cytomegalovirus corneal endotheliitis after penetrating keratoplasty.
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.
Wang
Shih-Chien
SC
Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan.
Tsai
I-Lun
IL
Lin
Hsiao-Cheng
HC
Kuo
Li-Lin
LL
Tsai
Ching-Yao
CY
Liou
Shiow-Wen
SW
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
D004279:DNA, Viral