Aqueous tapping at the time of corneal transplantation for PCR analysis of viral load may help improve the diagnosis and follow-up management of post-keratoplasty cytomegalovirus (CMV) endotheliitis, a recent study in the British Journal of Ophthalmology suggests.

This Taiwan-based study included 30 patients who had corneal transplants in 2011. The researchers analyzed the aqueous, recipient corneas and donor corneoscleral rims using PCR to look for the presence of CMV.

They found CMV DNA in three (10%) aqueous, eight (26.7%) recipient corneas and six (20.0%) donor corneas obtained during keratoplasty. Following the surgery, the study reported four patients who had CMV DNA in either aqueous or the recipient cornea were diagnosed with CMV endotheliitis. At an approximate five-year follow-up, eight (72.7%—including four with post-keratoplasty CMV endotheliitis) of the 11 patients with CMV positivity in any sample had graft failure. In comparison, researchers noted nine (47.3%) of the 19 patients without evidence of CMV DNA experienced graft failure.

“We found a relatively high prevalence of CMV DNA in the aqueous and corneas obtained during keratoplasty. All the patients who had CMV positivity in aqueous developed CMV endotheliitis postoperatively and experienced graft failure eventually,” researchers said. “Aqueous tapping at the time of corneal transplantation for PCR analysis may help to improve the diagnosis and follow-up management of post-keratoplasty CMV endotheliitis.”