Cytomegalovirus as an etiologic factor in corneal endotheliitis
Cytomegalovirus as an etiologic factor in corneal endotheliitis
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DOI：
10.1016/j.ophtha.2007.04.053
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发表时间：
2008-02-01
期刊：
影响因子：
13.7
通讯作者：
Kinoshita, Shigeru
中科院分区：
文献类型：
--
作者：
Koizumi, Noriko;Suzuki, Takashi;Kinoshita, Shigeru
目的：探讨日本2所大学医院收治的8例巨细胞病毒(CMV)所致角膜内皮炎患者的临床表现及抗病毒治疗效果。设计：多中心、连续、回顾性的病例系列研究。通过聚合酶链式反应检测房水中的CMV，而不是单纯疱疹病毒(HSV)和水痘带状疱疹病毒(VZV)的DNA，做出诊断。方法：回顾分析患者的临床表现和对抗病毒治疗的反应。主要观察指标：患者资料，包括角膜内皮炎的病程、全身疾病、眼压和前后节的临床表现。通过裂隙灯检查评估全身和局部抗病毒治疗的临床反应。结果：巨细胞病毒检测后的平均观察期为10.4个月(2~24个月)。所有患者均无全身性免疫缺陷。角膜表现包括伴有多发硬币状病变的线状角膜沉淀物和局部角膜基质水肿。8例患者中，4例行穿透性角膜移植。7例患者应用更昔洛韦全身治疗，1例患者应用万乃洛韦治疗，早期应用加洛韦后角膜内皮炎迅速缓解。复查时有6只眼角膜透明，2只眼有大泡性角膜病变。结论：在角膜内皮炎患者中，除HSV和VZV外，应考虑CMV的致病因素。巨细胞病毒角膜内皮炎可能是一种新发现的临床实体，在没有伴随全身症状的个体的前房中发现了重新激活的巨细胞病毒。
Purpose: To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan.Design: Retrospective, consecutive, multicenter case series.Participants: Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye.Methods: Retrospective review of the clinical manifestations and responses to antiviral treatment.Main Outcome Measures: Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy.Results: The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy.Conclusions: Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.