[Endothelial precipitates and cytomegalovirus infection]

In patients with the typical features of intraocular cytomegalovirus infection endothelial precipitates were identified that had a characteristic morphology, which included subtle, non-pigmented linear deposits with reticular arrangement that can spread diffusely over the corneal endothelium without preference for the inferior quadrants. The appearance of these precipitates was comparable to heterocromic cyclitis. Specular microscopy identified lymphocytes and macrophages on the endothelial layer. The present observations are based on five case reports of necrotizing retinitis, typical for intraocular cytomegalovirus infection, in connection with the atypical endothelial precipitates. In four of the five patients reported, HIV-infection was confirmed. In one patient with serologically confirmed cytomegalovirus infection (however without HIV-infection), a diagnostic work-up of the aqueous humor was carried out. Local production of specific antibodies against cytomegalovirus was identified in the aqueous humor. Topical treatment with antiviral and/or steroidal drugs was unsuccessful. The antiviral drug gancyclovir was applied systemically in two patients, but there was no impact on the corneal precipitates described. No intravitreal therapy was given. If these endothelial changes can be regarded as pathognomonic for cytomegalovirus infection, thorough slit lamp examination may be important for diagnosis of the presence of or the reactivation of cytomegalovirus infection in the eye. So far, no correlation has been found between the time course of corneal/endothelial precipitation and necrotizing retinitis.