To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan. Retrospective, consecutive, multicenter case series. Corneal endotheliitis can be classified clinically into four forms: linear, sectorial, disciform, and diffuse. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye. Retrospective review of the clinical manifestations and responses to antiviral treatment. Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. Stromal: Nummular keratitis: have anterior stromal granular deposits.
Innate immune mechanisms are important for first-line defense, but the virus demonstrates latency through an adaptive T-cell response involving primarily effector memory cytotoxic CD8+ T-cells… The average observation period after CMV detection was 10.4 months (range, 2-24 months). The resultant bow-tie con- ﬁguration is characteristic of pellucid marginal degeneration in left eye. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Risk of recurrence increases with time – ten per cent at one year, and 63 per cent by 20 years. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy.
Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.