Corneal endothellitis associated with evidence of cytomegalovirus infection

Objective: To describe the clinical presentation of cytornegalovirus (CMV) corneal endotheliitis in human immunodeficiency virus (HIV)-negative patients. Design: Retrospective interventional case series. Participants: Twelve consecutive patients with corneal endotheliffis diagnosed between 2002 and 2005. Methods: Aqueous of eyes with corneal encdotheliitis was analyzed for viral DNA by polymerase chain reaction (PCR), and patient records were reviewed for demographic data, medical and ocular history, best-corrected Snellen visual acuity, intraocular pressure (IOP), anterior and posterior segment findings, laboratory workup, diagnosis, and treatment. Main Outcome Measure: Presence of CMV DNA. Results: Corneal enclotheliffis was seen in 12 eyes of 10 patients during the study period. There were 8 men and 2 women, and all were Chinese. Their mean age was 49 years (range, 25-61 years). The corneal involvement ranged from small areas of focal endotheliitis to diffuse bullous keratopathy. The keratic precipitates had a variable appearance. There was only mild anterior chamber inflammation with no posterior synechiae. Two thirds of eyes had diffuse iris atrophy. All the eyes had elevated IOP. Eleven of the 12 eyes were positive for CMV DNA. None of the patients were positive for HIV. All patients had received local or systemic immunosuppression, or both, before corneal enclotheliffis developed. Ten eyes of 8 patients were treated with systemic antiviral therapy. After treatment, the enclotheliffis resolved completely in 7 eyes, and 3 eyes had significant improvement in corneal translucency. The IOP was normal, with no medications in all but 1 eye. Repeat PCR analysis in all the treated eyes was negative for CMV DNA. Conclusions: Cytomegalovirus infection is an important cause of corneal enclotheliffis in our patients, and appropriate antiviral therapy may prevent more ocular damage.