CYTOMEGALOVIRUS KERATITIS AFTER PENETRATING KERATOPLASTY

We report the development of cytomegalovirus (CMV) keratitis in the pe netrating keratoplasty of a 59-year-old human immunodeficiency virus-n egative woman after uncomplicated corneal transplantation. Immunosuppr ession with topical cyclosporine A 2% in corn oil and topical predniso lone acetate 1% suspension was used postoperatively. The 15-month post operative course was complicated by multiple episodes of endothelial r ejection, medically controlled elevated intraocular pressure, poly mic robial bacterial (coagulase-negative staphlococcus and a-hemolytic str eptococcus) keratitis, and endothelial plaque formation with associate d hypopyon and epithelial defect. The graft failed and penetrating ker atoplasty was repeated. Cytomegalovirus infection of superficial kerat ocytes in a region of scarring was identified in histological sections stained with hematoxylin and eosin and confirmed using mouse monoclon al anti-cytomegalovirus antibodies. Excision of the diseased corneal b utton with no additional treatment appears to have been curative. Low- grade keratitis was the only manifestation of the CMV infection, and i t has not recurred 6 months postoperatively.