Dr. Nafiz Körez Sincan State Hospital, Clinic of Ophthalmology, Ankara, Turkey.
Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
Turk J Ophthalmol. 2020 Oct 30;50(5):304-307. doi: 10.4274/tjo.galenos.2020.47568.
Cytomegalovirus (CMV)-related corneal endotheliitis is an inflammation of the corneal endothelium caused by CMV. It may occur de novo or after ocular surgery in otherwise healthy individuals. In patients who have undergone keratoplasty, the differential diagnosis of viral endotheliitis and immune-related graft rejection is challenging due to the similar clinical findings. Here we report a patient who underwent penetrating keratoplasty and was using local and systemic immunosuppressive agents due to previous history of graft rejection. At postoperative year 4, ophthalmologic examination revealed localized corneal edema, coin-shaped keratic precipitates, and increased intraocular pressure, consistent with viral endotheliitis. Polymerase chain reaction revealed CMV-DNA amplification in the aqueous humor sample. Valganciclovir treatment was started and the symptoms improved in 2 months. It should be kept in mind that local or systemic immunosuppressants used after keratoplasty may trigger CMV reactivation. Anti-CMV treatment should be initiated immediately in patients with coin-shaped keratic precipitates.
巨细胞病毒（CMV）相关性角膜内皮炎是由 CMV 引起的角膜内皮炎症。它可能在无其他健康问题的个体中初次发生，也可能在眼部手术后发生。在接受角膜移植术的患者中，由于临床发现相似，病毒性内皮炎和免疫相关移植物排斥反应的鉴别诊断具有挑战性。在这里，我们报告了一名患者，他因既往移植物排斥反应而接受穿透性角膜移植术，并使用局部和全身免疫抑制剂。术后 4 年，眼科检查显示局部角膜水肿、硬币状角膜后沉着物和眼内压升高，符合病毒性内皮炎。聚合酶链反应显示房水样本中 CMV-DNA 扩增。开始使用缬更昔洛韦治疗，2 个月后症状改善。应当记住，角膜移植术后使用的局部或全身免疫抑制剂可能会引发 CMV 再激活。对于出现硬币状角膜后沉着物的患者，应立即开始抗 CMV 治疗。
