# Cytomegalovirus Corneal Endotheliitis Presenting As Bullous Keratopathy: Resolution With Antiviral Therapy Alone

## TL;DR

A patient with severe corneal swelling was successfully treated with antiviral eye drops, avoiding the need for a corneal transplant.

## Contribution

Demonstrates that antiviral therapy alone can resolve CMV-related corneal endotheliitis, challenging the need for surgery.

## Key findings

- CMV was identified as the cause of steroid-resistant corneal edema using molecular testing.
- Treatment with ganciclovir eye drops significantly improved corneal edema and visual acuity.
- One-year follow-up confirmed sustained visual improvement without surgical intervention.

## Abstract

Bullous keratopathy is a condition that arises from corneal endothelial dysfunction, leading to corneal edema. Corneal transplantation has historically served as the standard treatment for cases with severe visual impairment due to edema, given the generally accepted irreversible nature of the condition. The present case report documents the successful management of a patient with steroid-resistant corneal edema through administering anti-cytomegalovirus (CMV) therapy, thereby underscoring the potential for alternative treatment modalities in cases of visual impairment due to corneal edema. A 73-year-old male patient presented at our clinic with steroid-resistant corneal edema. He had a 10-year history of recurrent right corneal endotheliitis. A thorough clinical evaluation revealed substantial corneal edema in the right eye, accompanied by an initial best-corrected visual acuity of 0.06 (20/333), which remained uncorrected by conventional optical aids. We proceeded with aqueous humor analysis via viral polymerase chain reaction testing, which revealed CMV positivity (while herpes simplex virus and varicella-zoster virus testing were negative). Consequently, the patient was diagnosed with CMV-related corneal endotheliitis, and treatment with 0.5% ganciclovir eye drops was initiated. Following treatment, a significant improvement in the corneal edema was observed, and the patient's best-corrected visual acuity recovered to 0.6-1.0 (20/33-20/20). This clinical experience underscores the significance of molecular diagnostic approaches in ophthalmic practice, illustrating how targeted antiviral therapy can effectively restore corneal function in cases previously regarded as suitable only for surgical intervention. Sustained visual improvement was documented throughout the one-year follow-up period, suggesting a paradigm shift in managing select cases of bullous keratopathy.