Cytomegalovirus endotheliitis and its diagnosis by confocal microscopy

Abstract

Objective: Describe the characteristics of the corneal endothelium by confocal microscopy in patients with inclusion basophilic lesions as pathognomonic signs of cytomegalovirus endotheliitis.

Methods: An observational study was conducted of clinical cases of patients diagnosed with cytomegalovirus endotheliitis attending the Cornea Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2010 to June 2018. The study sample was 39 patients with a clinical diagnosis of endotheliitis who underwent confocal microscopy with a Confoscan 4 device (Nidek Technologies).

Results: Of the 39 patients examined, 29 were male and 10 were female. All were aged 41-60 years. 97.4% had a history of viral conjunctivitis and only one was HIV positive (2.6%). Best corrected visual acuity was 0.3 or less in 100% before treatment, and 0.8 to 1.0 after treatment. Inclusion basophilic bodies visible by confocal microscopy were observed in the corneal endothelium of all patients.

Conclusions: A relationship exists between the presence of inclusion basophilic bodies in the corneal endothelium and virological tests positive for cytomegalovirus, making it possible to perform PCR testing in cases with confocal microscopy confirmation of the pathognomonic characteristics of the corneal endothelium.

Key words: Endotheliitis; cytomegalovirus; confocal microscopy.