Recurrent Cytomegalovirus Corneal Endotheliitis after Penetrating Keratoplasty

Abstract

Stress from surgery and corticosteroid usage can revitalize CMV activity. PCR and confocal microscopy are valuable for the diagnosis of CMV corneal endotheliitis.

Identification of cytomegalovirus and human herpesvirus-6 DNA in a patient with corneal endotheliitis

“…We were unable to find any previous reports of corneal endotheliitis positive for both CMV and HHV6 DNA in the PubMed database. The clinical features of this patient, such as coin-shaped lesions, IOP elevation, owl's eye cells under in vivo laser confocal microscopy and successful antiviral therapy (GCV/ VGCV), were consistent with those of typical CMV corneal endotheliitis in previous reports [1][2][3][4][5][6][7][8]. None of the clinical findings were different from CMV endotheliitis in our patient.…”

“…The patients may also have had past histories of several PKPs [2][3][4]. Owl's eye cells that have intranuclear inclusion bodies are frequently observed under in vivo laser confocal microscopy [5][6][7][8]. Usually, acyclovir and valacyclovir are not effective; instead, GCV and VGCV are effective to relieve the symptoms.…”

“…In addition, CMV is recognized as a new etiological factor for anterior uveitis and corneal endotheliitis in immunocompetent individuals [1][2][3][4][5][6][7][8]. Human herpesvirus-6 (HHV6) is also a member of the HHV family and has been associated with immunodeficiency disorders and neurological diseases.…”

Ganciclovir ophthalmic gel 0.15% for the treatment of acute herpetic keratitis: background, effectiveness, tolerability, safety, and future applications

“…Off-label uses include prevention of recurrent CMV retinitis and treatment of CMV pneumonitis, CMV neurological disease, progressive outer retinal necrosis caused by varicella-zoster virus, and certain human herpesvirus 8 diseases 20. Ganciclovir, both systemic and topical, has also been used with some success in treatment of CMV endothelitis 81–84. It is considered to be a first-line choice of therapy for these sight- and life-threatening CMV infections 85.…”

“…20 Ganciclovir, both systemic and topical, has also been used with some success in treatment of CMV endothelitis. 81 – 84 It is considered to be a first-line choice of therapy for these sight- and life-threatening CMV infections. 85 Ganciclovir has a broad spectrum of activity against a variety of viruses, including all human herpesviruses (including HSV-1, HSV-2, varicella-zoster virus, Epstein-Barr virus, CMV, and human herpesvirus 6) and adenovirus.…”