Koizumi Noriko, Suzuki Takashi, Uno Toshihiko, Chihara Hidemi, Shiraishi Atsushi, Hara Yuko, Inatomi Tsutomu, Sotozono Chie, Kawasaki Satoshi, Yamasaki Kenta, Mochida Chikako, Ohashi Yuichi, Kinoshita Shigeru
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ophthalmology. 2008 Feb;115(2):292-297.e3. doi: 10.1016/j.ophtha.2007.04.053. Epub 2007 Jul 31.
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.
Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. 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. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy.
The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. 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.
调查在日本两家大学医院被诊断并接受治疗的8例巨细胞病毒（CMV）性角膜内皮炎患者的临床表现及对抗病毒治疗的反应。
回顾性、连续性、多中心病例系列研究。
京都府立医科大学和爱媛大学医学院诊断为活动性CMV角膜内皮炎的8例患者的8只眼。诊断依据是通过聚合酶链反应检测患眼房水中的CMV DNA，而非单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）DNA。
回顾性分析临床表现及对抗病毒治疗的反应。
患者资料，包括角膜内皮炎病程、全身疾病、眼压以及眼前段和后段的临床表现。通过裂隙灯检查评估全身和局部抗病毒治疗的临床反应。用角膜内皮显微镜检查角膜内皮密度。
检测到CMV后的平均观察期为10.4个月（范围2 - 24个月）。所有患者均无全身免疫缺陷。角膜表现包括与多个钱币状病变相关的线状角膜后沉着物和局部角膜基质水肿。8例患者中4例接受了穿透性角膜移植。7例患者使用全身更昔洛韦治疗，1例患者使用伐昔洛韦，角膜内皮炎对早期给予更昔洛韦反应迅速。在最后一次检查时, 6只眼角膜清亮，但2只眼发生了大疱性角膜病变。
除HSV和VZV外，角膜内皮炎患者必须考虑CMV作为病原体。CMV角膜内皮炎可能是无前驱全身症状个体前房内CMV再激活的一种新发现的临床实体。
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