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Cytomegalovirus as a cause of recurrent corneal endotheliitis in the Canadian population

      Abstract

      Objective

      To report the clinical manifestations, response to antiviral treatment, and long-term visual outcomes of cytomegalovirus endotheliitis in a Canadian population.

      Design

      Retrospective case series.

      Participants

      A total of 9 eyes of 7 patients referred to a cornea subspecialty clinic in a major Canadian centre with corneal endotheliitis.

      Methods

      A retrospective review of all patients presenting with corneal endotheliitis to 1 corneal surgeon was completed. Patients underwent anterior chamber biopsy with positive cytomegalovirus polymerase chain reaction. All patients received systemic valganciclovir for a minimum of 3 months. Primary outcomes included visual acuity, intraocular pressure control, medication dependence, and corneal status.

      Results

      The average follow-up was 76.4 ± 11.8 months. Two patients had bilateral disease. Corneal manifestations included linear, disciform, and circinate patterns of endotheliitis. Best-corrected visual acuity improved from a mean of 0.48 ± 0.19 logMAR at presentation to 0.24 ± 0.11 logMAR at last follow-up. Intraocular pressure decreased from a peak of 35 ± 3.1 mm Hg to 14.2 ± 4.3 mm Hg. Antiglaucoma medications were reduced from 2.6 ± 0.45 to 0.89 ± 0.29 agents. Two eyes required endothelial transplantation. Valganciclovir therapy was well tolerated by all patients; at the time of last follow-up, all patients were stable on low-dose valganciclovir at an average dose of 1395 mg per week.

      Conclusions

      Cytomegalovirus is an uncommon but clinically significant cause of corneal endotheliitis that must be considered in the differential diagnosis of corneal endotheliitis, even in the immunocompetent population. Our results support prior findings that this entity responds robustly to oral valganciclovir and demonstrate for the first time the efficacy of chronic low-dose antiviral maintenance therapy.
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      References

        • Koizumi N
        • Yamasaki K
        • Kawasaki S
        • et al.
        Cytomegalovirus in aqueous humor from an eye with corneal endotheliitis.
        Am J Ophthalmol. 2006; 141: 564-565
        • Koizumi N
        • Inatomi T
        • Suzuki T
        • et al.
        Clinical features and management of cytomegalovirus corneal endotheliitis: analysis of 106 cases from the Japan corneal endotheliitis study.
        Br J Ophthalmol. 2015; 99: 54-58
        • Chee S-P
        • Bacsal K
        • Jap A
        • Se-Thoe S-Y
        • Cheng CL
        • Tan BH.
        Corneal endotheliitis associated with evidence of cytomegalovirus infection.
        Ophthalmology. 2007; 114: 798-803
        • Su CC
        • Hu FR
        • Wang TH
        • et al.
        Clinical outcomes in cytomegalovirus-positive Posner–Schlossman syndrome patients treated with topical ganciclovir therapy.
        Am J Ophthalmol. 2014; 158: 1024-1031
        • Sobolewska B
        • Deuter C
        • Doycheva D
        • Zierhut M.
        Long-term oral therapy with valganciclovir in patients with Posner–Schlossman syndrome.
        Graefes Arch Clin Exp Ophthalmol. 2014; 252: 117-124
        • Fan N-W
        • Chung Y-C
        • Liu Y-C
        • Liu CJ-L
        • Kuo Y-S
        • Lin P-Y.
        Long-term topical ganciclovir and corticosteroids preserve corneal endothelial function in cytomegalovirus corneal endotheliitis.
        Cornea. 2016; 35: 596-601
        • Koizumi N
        • Miyazaki D
        • Inoue T
        • et al.
        The effect of topical application of 0.15% ganciclovir gel on cytomegalovirus corneal endotheliitis.
        Br J Ophthalmol. 2017; 101: 114-119
        • Tabbara KF
        • Balushi NA.
        Topical ganciclovir in the treatment of acute herpetic keratitis.
        Clin Ophthalmol. 2010; 19: 905-912
        • Chee S-P
        • Japad A.
        Immune ring formation associated with cytomegalovirus endotheliitis.
        Am J Ophthalmol. 2011; 152: 449-453