穿透性角膜移植术后复发性巨细胞病毒性角膜内皮炎
Recurrent cytomegalovirus corneal endotheliitis after penetrating keratoplasty.
作者信息
Wang Shih-Chien, Tsai I-Lun, Lin Hsiao-Cheng, Kuo Li-Lin, Tsai Ching-Yao, Liou Shiow-Wen
机构信息
Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan.
出版信息
Eur J Ophthalmol. 2010 Mar-Apr;20(2):457-9. doi: 10.1177/112067211002000231.
PURPOSE
To report a case of recurrent cytomegalovirus (CMV) corneal endotheliitis after penetrating keratoplasty.
METHODS
Penetrating keratoplasty (PK) was performed in a 49-year-old man with bullous keratopathy. Pigmented keratic precipitates (KPs) were found in the corneal endothelium of the graft 13 days after surgery, with the subsequent appearance of coin-shaped lesions. Confocal microscopy was performed on the corneal endothelium. Aqueous humor was analyzed for viral DNA by polymerase chain reaction (PCR).
RESULTS
CMV DNA was detected from the excised corneal button, and aqueous humor revealed positive results for CMV and HSV1 by PCR. Confocal microscopy showed large corneal endothelial cells, consistent with the typical owl's eye morphology of CMV endotheliitis. After systemic ganciclovir was administered, the pigmented KPs and coin-shaped lesions gradually decreased.
CONCLUSIONS
Stress from surgery and corticosteroid usage can revitalize CMV activity. PCR and confocal microscopy are valuable for the diagnosis of CMV corneal endotheliitis.
目的
报告1例穿透性角膜移植术后复发性巨细胞病毒（CMV）角膜内皮炎病例。
方法
对1例患有大泡性角膜病变的49岁男性进行穿透性角膜移植术（PK）。术后13天在移植片的角膜内皮发现色素性角膜后沉着物（KP），随后出现钱币状病变。对角膜内皮进行共焦显微镜检查。通过聚合酶链反应（PCR）分析房水的病毒DNA。
结果
从切除的角膜植片中检测到CMV DNA，并且房水PCR检测显示CMV和单纯疱疹病毒1型（HSV1）呈阳性结果。共焦显微镜检查显示角膜内皮细胞增大，符合CMV内皮炎典型的猫头鹰眼形态。给予全身更昔洛韦治疗后，色素性KP和钱币状病变逐渐减少。
结论
手术应激和皮质类固醇的使用可使CMV活性恢复。PCR和共焦显微镜检查对CMV角膜内皮炎的诊断有重要价值。
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