title: Cytomegalovirus-positive corneal stromal edema with keratic precipitates after penetrating keratoplasty: a case-control study.
abstract: OBJECTIVE
  To identify differences between cytomegalovirus (CMV)-positive and CMV-negative eyes presenting as suspected endothelial graft rejection after penetrating keratoplasty (PK).
  
  
  METHODS
  A retrospective consecutive case-control series. Aqueous humor samples of all eyes with corneal stromal edema and keratic precipitates (KPs) after PK, seen at the Singapore National Eye Centre from 2007 to 2010, were analyzed for CMV DNA by polymerase chain reaction. Their charts were reviewed for demographic data, medical and ocular history, best-corrected visual acuity, intraocular pressure, anterior segment clinical findings, and therapy.
  
  
  RESULTS
  Of 11 eligible eyes (11 patients), 7 were CMV positive. All eyes were negative for herpes simplex virus and varicella zoster virus. The 2 groups were similar in age, gender, and previous ocular surgery. The main differences were the presence of extensive heavily pigmented KPs, Descemet membrane folds, and the absence of vascularization of the donor in CMV-positive eyes (100% vs. 0%, P = 0.003, Fisher exact test). All the CMV-positive eyes were treated with ganciclovir (5 systemic, 2 topical), and the control eyes received immunosuppression. However, all the grafts failed. Best-corrected visual acuity at the last visit was worse than 20/400 in all except 1 control eye, which had a follow-up of 30 months.
  
  
  CONCLUSIONS
  There is a high prevalence of CMV infection in eyes that develop corneal stromal edema with KPs after PK. Heavy endothelial pigmentation, Descemet membrane folds, and the absence of donor vascularization may aid in the diagnosis of CMV in the event that aqueous analysis is not possible.
authors.affiliation: Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore, Singapore. chee.soon.phaik@snec.com.sg
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
authors.forename: Aliza
authors.initials: A
authors.lastname: Jap
authors.forename: Elaine Chee Wen
authors.initials: EC
authors.lastname: Ling
authors.forename: Seng-Ei
authors.initials: SE
authors.lastname: Ti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D016022:Case-Control Studies; D015715:Corneal Edema / Q000473:pathology / Q000601:surgery / Q000821:virology; D003319:Corneal Stroma / Q000473:pathology / Q000821:virology*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000473:pathology; D015828:Eye Infections, Viral / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015774:Ganciclovir