Prevalence and Features of Keratitis with Quantitative Polymerase Chain Reaction Positive for Cytomegalovirus
Prevalence and Features of Keratitis with Quantitative Polymerase Chain Reaction Positive for Cytomegalovirus
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DOI：
10.1016/j.ophtha.2009.06.059
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发表时间：
2010-02-01
期刊：
影响因子：
13.7
通讯作者：
Tano, Yasuo
中科院分区：
文献类型：
--
作者：
Kandori, Michiko;Inoue, Tomoyuki;Tano, Yasuo
目的：评估角膜刮片和房水样本经聚合酶链反应（PCR）分析为巨细胞病毒（CMV）阳性的不明原因角膜炎患者，并调查其临床表现。设计：回顾性干预性病例系列。参与者：在大坂大学医学院接受检查的78例不明原因的上皮性角膜炎（n = 37）、基质性角膜炎（n = 12）或内皮性角膜炎（n = 29）患者。临床检查和眼泪，角膜刮片，和房水标本进行了评价，通过实时PCR为CMV.Main结果指标：定量CMV DNA在诊断的每种类型的角膜炎与未知的起源和监测在治疗过程中CMV阳性cases.Results：没有上皮或基质角膜炎的情况下有CMV DNA。29例角膜内皮炎中7例CMV阳性（24.1%）。巨细胞病毒阳性的角膜内皮炎病例以局部角膜水肿和角膜沉淀物为特征，包括4例接受穿透性角膜移植术且对移植物排斥治疗无效的患者和3例特发性内皮炎患者。估计巨细胞病毒DNA拷贝数，范围为6.3 x 10（4）至3.6 x 10（6）/ml。在所有阳性病例中，CMV DNA拷贝数在全身和局部更昔洛韦（GCV）联合局部类固醇治疗期间数周内下降。5只眼（62.5%）临床症状改善。在内皮性角膜炎的病例中，CMV阳性患者中糖尿病的发病率明显较高（71.4%）高于CMV阴性患者（18.2%，P = 0.016，卡方检验）。共24.1%的不明原因角膜水肿患者CMV阳性，应包括在特发性角膜内皮炎或移植后水肿的鉴别诊断中。穿透性角膜移植术，特别是大泡性角膜病变。实时PCR的CMV，诊断和监测的临床过程的基础上，可能是有用的。巨细胞病毒角膜内皮炎需要早期使用GCV进行适当治疗。由于GCV后的临床缓解可能取决于正常内皮细胞的面积，因此早期诊断和治疗对于CMV角膜内皮炎非常重要。财务披露：作者对本文中讨论的任何材料没有专有或商业利益。Ophthalmology 2010; 117：216-222（C）2010，美国眼科学会。
Purpose: 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.Design: Retrospective, interventional case series.Participants: 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.Methods: Clinical examination and tears, corneal scrapings, and aqueous humor specimens were evaluated by real-time PCR for CMV.Main Outcome Measures: 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.Results: 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 6.3 x 10(4) to 3.6 x 10(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).Conclusions: 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.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010; 117: 216-222 (C) 2010 by the American Academy of Ophthalmology.