title: Immune ring formation associated with cytomegalovirus endotheliitis.
abstract: OBJECTIVE
  To describe immune ring (IR) formation as a manifestation of cytomegalovirus (CMV) endotheliitis.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Review of all consecutive CMV anterior uveitis and endotheliitis patients seen at the Singapore National Eye Centre for the occurrence of an IR. CMV infection was diagnosed by polymerase chain reaction analysis of the aqueous.
  
  
  RESULTS
  None of the 72 eyes with CMV anterior uveitis had an IR formation. Four episodes of IR formation were seen in 3 eyes (14.3%) of 21 cases of CMV-positive endotheliitis. All were unilateral and all 3 patients were human immunodeficiency virus negative middle-aged Chinese males. The IR developed 2 to 7 months after occurrence of the endotheliitis and the aqueous was positive for CMV during 2 of the episodes of IR formation. In 2 eyes, the IR occurred at the completion of a course of systemic ganciclovir when the aqueous was negative for CMV. The immune rings resolved with combination therapy of topical prednisolone acetate 0.12% and ganciclovir. Patient 1 had a recurrence of the IR 4 months after stopping treatment but again resolved following treatment with ganciclovir and topical corticosteroids.
  
  
  CONCLUSIONS
  Corneal immune rings can occur as a result of CMV infection. Hence CMV infection may have to be considered in such cases.
authors.affiliation: Singapore National Eye Centre, Singapore; National University Health System, Singapore; Singapore Eye Research Institute, Singapore. Electronic address: chee.soon.phaik@snec.com.sg.
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
authors.affiliation: Singapore National Eye Centre, Singapore; Division of Ophthalmology, Changi General Hospital, Singapore.
authors.forename: Aliza
authors.initials: A
authors.lastname: Jap
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D004359:Drug Therapy, Combination; D004728:Endothelium, Corneal / Q000276:immunology*; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011234:Precipitins / Q000276:immunology; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014606:Uveitis, Anterior / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D011234:Precipitins; C009935:prednisolone acetate; D011239:Prednisolone; D015774:Ganciclovir