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Cytomegalovirus associated corneal endotheliitis after penetrating keratoplasty in a patient with Fuchs corneal endothelial dystrophy
  1. Hsueh-Yen Chu1,
  2. Chi-Chin Sun2,3,
  3. Wen-Yu Chuang4,
  4. Shiow-Wen Liou5,
  5. David HK Ma1,2,
  6. Chi-Chun Lai1,2,
  7. Yih-Shiou Hwang1,6,
  8. Ching-Hsi Hsiao1,2
  1. 1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
  2. 2College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
  3. 3Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
  4. 4Department of Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
  5. 5Department of Ophthalmology, Taipei City Hospital, Taiwan, Republic of China
  6. 6Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
  1. Correspondence to Dr Yih-Shiou Hwang and Ching-Hsi Hsiao, Department of Ophthalmology, Chang Gung Memorial Hospital, No 199, Tung Hwa North Road, Taipei, 105, Taiwan, Republic of China; yihshiou.hwang{at}gmail.com and hsiao.chinghsi{at}gmail.com

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Corneal endotheliitis, a specific inflammation targeted primarily to the corneal endothelium, is characterised by cornea oedema, keratic precipitates (KPs) and a mild anterior chamber reaction.1–3 Several viruses, including herpes simplex virus (HSV), varicella zoster virus (VZV), mumps and cytomegatovirus (CMV), have been implicated in the aetiology of the disease.1–3 Based on its definition, allograft endothelial rejection after keratoplasty can be included in the corneal endotheliitis. Here, we report a patient with corneal endotheliitis occurring after penetrating keratoplasty for Fuchs corneal endothelial dystrophy.

Case report

A 65-year-old Taiwanese female without previous ocular illness but arrhythmias and mitral valve prolapse history presented with progressive corneal oedema and decreased vision in the right eye in 1994. She was diagnosed as having bilateral Fuchs endothelial dystrophy, confirmed by slit-lamp biomicroscopy and specular microscopy (figure 1). The best-corrected vision was 20/50 in her right eye and 20/30 in her left eye, and the corneal thickness as measured with pachymetry was 550 μm in her right eye and 510 μm in her left eye in 2004. The patient then received her first penetrating keratoplasty (PK) in March 2004. Elevated intraocular pressure (IOP) measured 41 mm Hg at the highest with KPs, but a clear corneal graft was found 7 months after transplantation. Despite antiglaucomatous medication use, pigmented and non-pigmented KPs with stromal oedema as well as intractable high IOP remained. Trabeculectomy was performed 3 months prior to a second PK with extracapsular cataract extraction and intraocular lens implantation in June 2005. Elevated IOP persisted postoperatively (31.8 mm Hg at the highest), so the patient received trans-scleral cyclophotocoagulation in September 2005; IOP has returned to normal …

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