Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
Ophthalmology. 2010 Feb;117(2):216-22. doi: 10.1016/j.ophtha.2009.06.059. Epub 2009 Dec 6.
To assess corneal scrapings and aqueous humor samples analyzed by polymerase chain reaction (PCR) that were positive for cytomegalovirus (CMV) in patients with keratitis of unknown origin and to investigate their clinical manifestations.
Retrospective, interventional case series.
Seventy-eight patients with epithelial (n=37), stromal (n=12), or endothelial keratitis (n=29) of unknown origin examined at the Osaka University Medical Hospital.
Clinical examination and tears, corneal scrapings, and aqueous humor specimens were evaluated by real-time PCR for CMV.
Quantification of CMV DNA at the diagnosis of each type of keratitis with unknown origin and monitoring during the therapeutic course for CMV-positive cases.
No cases of epithelial or stromal keratitis had CMV DNA. Seven of 29 corneal endotheliitis cases (24.1%) were positive for CMV. Cytomegalovirus-positive cases of corneal endotheliitis characterized by localized corneal edema and keratic precipitates included 4 patients who had undergone penetrating keratoplasty and were refractory to the treatment for graft rejection and 3 patients with idiopathic endotheliitis. Cytomegalovirus DNA copy numbers were estimated and ranged from 6.3x10(4) to 3.6x10(6)/ml. In all positive cases, the numbers of CMV DNA copies decreased within weeks during treatment with systemic and topical ganciclovir (GCV) combined with a topical steroid. Five eyes (62.5%) had clinical improvement. In cases of endothelial keratitis, diabetes mellitus was significantly higher in patients positive for CMV (71.4%) than in patients negative for CMV (18.2%, P=0.016, chi-square test).
A total of 24.1% of cases with corneal edema of unknown origin were CMV positive and should be included in the differential diagnosis of idiopathic corneal endotheliitis or graft edema after penetrating keratoplasty, especially for bullous keratopathy. Real-time PCR for CMV, based on the diagnosis and monitoring of the clinical course, may be useful. Cytomegalovirus corneal endotheliitis requires early appropriate treatment using GCV. Because clinical remission after GCV may depend on the area of normal endothelium, early diagnosis and therapy are important for CMV corneal endotheliitis.
评估聚合酶链反应（PCR）检测为巨细胞病毒（CMV）阳性的角膜刮片和房水样本，并研究其临床表现。
回顾性干预性病例系列研究。
在大阪大学医学医院检查的 78 名原因不明的角膜炎患者，包括上皮性（n=37）、基质性（n=12）或内皮性角膜炎（n=29）。
通过实时 PCR 对 CMV 进行临床检查和泪液、角膜刮片和房水标本检测。
每种类型的原因不明的角膜炎的 CMV DNA 定量诊断和 CMV 阳性病例的治疗过程监测。
无上皮性或基质性角膜炎患者的 CMV DNA。29 例角膜内皮炎中有 7 例（24.1%）CMV 阳性。CMV 阳性的角膜内皮炎表现为局限性角膜水肿和角膜后沉着物，包括 4 例接受穿透性角膜移植且对移植排斥治疗无反应的患者和 3 例特发性内皮炎患者。CMV DNA 拷贝数进行了估计，范围从 6.3x10(4)到 3.6x10(6)/ml。在所有阳性病例中，全身和局部使用更昔洛韦（GCV）联合局部皮质类固醇治疗数周内 CMV DNA 拷贝数均下降。5 只眼（62.5%）有临床改善。在内皮性角膜炎中，CMV 阳性患者的糖尿病患病率明显高于 CMV 阴性患者（71.4%比 18.2%，P=0.016，卡方检验）。
原因不明的角膜水肿病例中，24.1%的病例 CMV 阳性，应纳入特发性角膜内皮炎或穿透性角膜移植后移植水肿的鉴别诊断，特别是大泡性角膜病变。基于诊断和监测临床病程的 CMV 实时 PCR 可能有用。CMV 性角膜内皮炎需要使用 GCV 进行早期适当治疗。由于 GCV 后的临床缓解可能取决于正常内皮细胞的面积，因此对 CMV 性角膜内皮炎进行早期诊断和治疗非常重要。
