In Vivo Imaging of Coin-Shaped Lesions in Cytomegalovirus Corneal Endotheliitis by Anterior Segment Optical Coherence Tomography

Purpose: The aim of this study was to investigate in vivo corneal changes of coin-shaped lesions in cytomegalovirus corneal endotheliitis using anterior segment optical coherence tomography (AS-OCT). Methods: Two eyes of 2 patients (69- and 71-year-old men), with polymerase chain reaction–proven CMV corneal endotheliitis presenting coin-shaped lesions, were included in this study. AS-OCT examination was performed on the initial visit and at follow-up visits by paying special attention to the coin-shaped lesions. Selected AS-OCT images of the cornea were evaluated qualitatively for changes in the shape and degree of light reflection. Results: In both cases, coin-shaped lesions were observed at the corneal endothelial surface as clusters of fine precipitates using slit-lamp biomicroscopy. Using AS-OCT, high-resolution images of the putative coin-shaped lesions were successfully obtained in both patients as an irregularly thickened highly reflective endothelial cell layer. After anti-CMV treatment, the coin-shaped lesions were resolved as assessed by slit-lamp biomicroscopy and AS-OCT in both patients. Conclusions: High-resolution AS-OCT provides novel and detailed visual information of coin-shaped lesions in patients with CMV corneal endotheliitis. Visualization of coin-shaped lesions by AS-OCT may be a useful adjunct to the diagnosis and follow-up of CMV corneal endotheliitis.