Original articleCytomegalovirus as an Etiologic Factor in Corneal Endotheliitis
Section snippets
Patients and Methods
The study population consisted of 8 consecutive patients whose active corneal endotheliitis was diagnosed and treated between November 2004 and May 2006 at the Departments of Ophthalmology of Kyoto Prefectural University of Medicine (patients 1–5) and Ehime University School of Medicine (patients 6–8). Of these 8 patients, patients 1 and 6 were previously reported as individual case reports by these 2 departments independently13, 14; they are also included here with more detailed information of
Results
The aqueous humor collected from the affected eyes of patients 1 through 5 contained CMV, but not HSV or VZV DNA. For these 5 eyes, the specificity of the amplified band was confirmed by Southern blot analysis.17 Under the same PCR conditions, none of 5 aqueous samples from cataract patients nor 7 aqueous samples from patients with uveitis demonstrated positive results for CMV, HSV, or VZV DNA. Likewise, the aqueous humor from the affected eyes of patients 6 through 8 contained CMV, but neither
Patient 4
A 51-year-old man began to experience recurrent episodes of bilateral corneal endotheliitis of unknown origin in the 1980s (Fig 1C). Aqueous humor samples subjected to PCR at the time of his previous attack returned negative results for HSV and VZV; CMV was not examined at that time. Despite HSV-targeting combination treatment consisting of oral acyclovir and topical acyclovir and corticosteroid, his corneal endotheliitis recurred often and he experienced bullous keratopathy. He had undergone
Discussion
The mechanisms regulating the latency and reactivation of CMV in the course of natural infection remain poorly understood. Cytomegalovirus DNA has been detected in human peripheral blood monocytes24, 25 and CD34+ bone marrow progenitors.26 The clinical observations that corneal endothelial lesions always start from the periphery and move toward the center of the cornea imply that tissues surrounding the cornea such as the trabecular meshwork or ciliary body may be the reservoir for CMV. The
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Manuscript no. 2007-125.
The authors have no commercial or financial interests associated with the article.
Supported in part by research grants from the Ministry of Education, Culture, Sports, Science, and Technology, Tokyo, Japan.
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Drs Koizumi and Suzuki contributed equally as co–first authors.