Clinical Features of Keratouveitis Associated with Cytomegalovirus Infection

巨細胞病毒導致角膜葡萄膜炎之臨床表現

田彭太(Peng-Tai Tien) ； 蔡宜佑(Yi-Yu Tsai) ； 林彩秀(Tsai-Hsiu Lin) ； 江鈞綺(Chun-Chi Chiang)

《中華民國眼科醫學會雜誌》 49卷1期 (2010/03) Pp. 78-86

https://doi.org/10.30048/ACTASOS.201003.0012

摘要

目的：報告與巨細胞病毒感染有關之角膜葡萄膜炎一例。
方法：病例報告。
結果：一位44歲男性左眼眼壓上升反覆發作已兩年，眼部表現包含角膜基質／上皮小泡性水腫、角膜沉降物及眼壓上升。病灶在口服valaciclovir一個月後並無消退，經房水聚合酶鏈鎖反應偵測到巨細胞病毒基因組。施行小樑切除術以控制眼壓，在接受靜脈注射ganciclovir（450mg，每12小時一次共1周）並接續口服valganciclovir（900mg，一天兩次）兩個月後，角膜完全透明且原有角膜沉降物消失，眼壓亦回到正常範圍：然而角膜細胞數目測定儀卻偵測到受影響角膜之低內皮細胞密度。
結論：巨細胞病毒角膜葡萄膜炎之臨床表現可能與Posner-Schlossman syndrome及Fuchs heterochromic iridocyclitis類似，當高度懷疑角膜葡萄膜炎時，即早施行單純疱疹病毒及巨細胞病毒房水聚合酶鏈鎖反應檢驗將有助於降低延遲診斷之機率。相較於靜脈注射ganciclovir，口服valganciclovir不單單可縮短住院天數，亦帶給患者較大的便利性。

並列摘要

Purpose: To report a case of keratouveitis associated with cytomegalovirus infection.
Method: Interventional case report.
Result: We examined a 44-year-old male who had been suffering from recurrent elevated intraocular pressure (IOP) in the left eye for 2 years. The ocular manifestations included stromal and epithelial microcystic corneal edema, keratic precipitates, and elevated IOP. The lesion did not subside after treatment with oral valaciclovir for a week. The cytomegalovirus (CMV) genome was detected in the aqueous humor by means of the polymerase chain reaction (PCR). The IOP was controlled by performing a trabeculectomy. Treatment with intravenous ganciclovir (450 mg, Q12H(superscript *) 1 week) followed by oral valganciclovir (900 mg BID) for 2 months returned the cornea to complete clarity without keratic precipitates. The IOP also returned to the normal range. However, we detected a low endothelial cell density of the affected cornea by specular microscopy.
Conclusion: The clinical presentation of CMV keratouveitis may resemble that of Posner-Schlossman syndrome or Fuchs heterochromic iridocyclitis. If CMV keratouveitis is suspected, then early PCR analysis of the aqueous humor could lower the rate of delayed diagnosis. Compared with intravenous ganciclovir, oral valganciclovir not only shortens the hospitalization period but also offers greater convenience to patients.

並列關鍵字

Cytomegalovirus ； Keratouveitis ； Polymerase chain reaction ； Valganciclovir