CORNEAL ENDOTHELIAL CHANGES IN CYTOMEGALOVIRUS RETINITIS

Reticular deposits on the corneal endothelium together with fundus changes typical of cytomegalovirus (CMV) retinitis have been noted in patients with acquired immune deficiency syndrome (AIDS). The aim of this study was to characterise this finding using specular microscopy and to assess the potential of this clinical sign as a screening tool which could be performed rapidly at the slit lamp without the need for dilatation of the pupil. Sixty male homosexual patients with a diagnosis of AIDS as defined by the Center for Disease Control (Atlanta, 1987) were examined at their first visit to the ophthalmic clinic. The cornea was examined at the slit lamp prior to fundal examination and the presence or absence of the characteristic endothelial changes noted. CMV retinitis was diagnosed on the basis of the fundal appearance together with confirmation of the diagnosis by analysis of a vitreous sample. As a diagnostic sign of CMV retinitis the endothelial changes had a positive predictive value of 94.7% and a negative predictive value of 75.6%. Although the presence of the endothelial changes always indicates the presence of CMV retinitis it is not a sign which is found in a high enough proportion of patients to allow its reliable use as a screening tool.