Corneal Ring Infiltrate in a Patient with Cytomegalovirus Endotheliitis: A Case Report

Abstract

Purpose: To report the observation of corneal ring infiltrate in a patient with cytomegalovirus (CMV) corneal endotheliitis. Methods: Single interventional case report. Results: A 37-year-old man presented with a 6-month history of multiple recurrent attacks of inflammatory glaucoma in both eyes. A diagnosis of Posner-Schlossman syndrome was made 10 years previously. Slit-lamp examination showed a well-defined patch of endotheliitis and some keratic precipitates in both corneas. The intraocular pressure was elevated in both eyes. Aqueous humor sampling for viral DNA detection by polymerase chain reaction was positive for CMV and negative for herpes simplex virus (HSV) type 1, HSV type 2, and varicella zoster virus. After the patient used topical ganciclovir and prednisolone, the endotheliitis resolved and the intraocular pressure was under control. However, the anterior chamber inflammation recurred in both eyes whenever the topical eye drops were discontinued. Moreover, a prominent double ring stromal infiltrate centering on the previous endotheliltis area was observed in the left cornea. The ring infiltrate and new keratic precipitates disappeared progressively after the topical eye drops were reapplied. At the 12-month follow-up examination, no recurrence of ring infiltrate was noted after use of topical ganciclovir and prednisolone eye drops. Conclusion: Corneal ring infiltrate has not been reported previously in CMV endotheliitis. This finding suggests that CMV leading to corneal endotheliitis can also induce the antigen-antibody immunologic reaction analogous to that of HSV immune ring infiltrate.