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CMV endotheliitis: a cause for recurrent failed corneal transplant
Nurul Ain Shahrudin1, Aida Zairani Mohd Zahidin1, Umi Kalthum Md Noh1
1Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
GMS Ophthalmology Cases
|January 13, 2018
Summary
Cytomegalovirus (CMV) endotheliitis is a significant cause of corneal transplant failure. Early diagnosis via anterior chamber tap, even without coin-shaped keratic precipitates, is crucial for preventing graft rejection and endothelial cell loss.
Area of Science:
- Ophthalmology
- Transplant Surgery
- Infectious Diseases
Background:
- Recurrent penetrating keratoplasty (PK) failure poses diagnostic challenges.
- Cytomegalovirus (CMV) endotheliitis is an emerging cause of corneal graft dysfunction.
- Distinguishing CMV endotheliitis from other causes of graft failure is critical.
Observation:
- Three cases of recurrent PK failure due to CMV endotheliitis are presented.
- Patients exhibited varied histories, including pseudophakia and prior uveitis.
- Clinical signs included pigmented keratic precipitates (KP), with two cases showing coin-shaped KP.
Findings:
- Diagnosis was confirmed by positive aqueous humor culture for CMV.
- Visual acuity ranged from 1/60 to hand movement.
- Treatment involved oral valganciclovir and topical ganciclovir, with positive response in one case.
Implications:
- Anterior chamber tap is recommended for suspicious cases of repeated corneal transplant failure.
- Early diagnosis and treatment of CMV endotheliitis prevent endothelial cell loss.
- Prompt management can avoid unnecessary treatments and improve graft survival rates.
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