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Recurrent cytomegalovirus corneal endotheliitis after penetrating keratoplasty

Shih-Chien Wang1, I-Lun Tsai, Hsiao-Cheng Lin

  • 1Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan.

European Journal of Ophthalmology
|December 29, 2009
PubMed
Abstract

Insights

Recurrent cytomegalovirus (CMV) corneal endotheliitis after penetrating keratoplasty was observed. Diagnosis was aided by PCR and confocal microscopy, with treatment involving ganciclovir.

Area of Science:

  • Ophthalmology
  • Virology
  • Microbiology

Background:

  • Corneal transplantation, or penetrating keratoplasty (PK), is a common procedure for vision restoration.
  • Recurrent cytomegalovirus (CMV) corneal endotheliitis can occur post-keratoplasty, posing a risk to graft survival.

Observation:

  • A 49-year-old male patient developed pigmented keratic precipitates and coin-shaped lesions on the corneal endothelium 13 days post-PK.
  • Confocal microscopy revealed characteristic owl's eye morphology in corneal endothelial cells.
  • Polymerase chain reaction (PCR) detected cytomegalovirus (CMV) DNA in the excised corneal button and aqueous humor.

Findings:

  • Cytomegalovirus (CMV) corneal endotheliitis recurred after penetrating keratoplasty.
  • Both PCR and confocal microscopy proved valuable in diagnosing CMV corneal endotheliitis.
  • Systemic ganciclovir treatment led to the gradual resolution of clinical signs.

Implications:

  • Surgical stress and corticosteroid use can reactivate latent cytomegalovirus (CMV).
  • Early diagnosis and treatment are crucial for managing post-keratoplasty CMV endotheliitis.
  • This case highlights the importance of considering viral etiologies in graft dysfunction.

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