Descemet Stripping Automated Endothelial Keratoplasty Outcomes in Patients With Cytomegalovirus Endotheliitis

López, Ester Fernández; Chan, Elsie

doi:10.1097/ico.0000000000001028

Cited by 18 publications

(5 citation statements)

References 21 publications

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“…Corneal graft survival has been shown to be negatively affected by inflammation, with higher rates of PGF. 20,[27][28][29][30] In addition, secondary IOL implantation has sometimes been associated with hypotony due to the various incisions involved, which may compromise the achievement of a sufficiently high intraocular pressure for graft attachment when combining surgeries. 7,27,31,32 Despite this potential challenge with hypotony, the difference in the incidences of graft detachment and PGF between the 2 groups was not statistically significant (graft detachment, P = 0.102; PGF, P = 0.468).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach

Goodman

Mittal

Awidi

et al. 2022

Cornea

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Section: Discussionmentioning

confidence: 99%

Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach

Goodman

Mittal

Awidi

et al. 2022

Cornea

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“…Treatment of corneal endothelial decompensation may require a corneal graft. A timely identification of CMV as the causative agent of a corneal failure is particularly important, since early and thorough inflammation control may improve the graft survival 13 . Moreover, post-operative CMV reactivation may occur, and it may be clinically indistinguishable from an episode of endothelial graft rejection.…”

Section: Discussionmentioning

confidence: 99%

“…CMV-specific medication such as ganciclovir and/or valganciclovir should be initiated before surgery and continued for at least six weeks after surgery. Therefore, CMV should be suspected as the causative agent of an endothelial decompensation in any unilateral hypertensive uveitis in immunocompetent patients, and an AC paracenthesis should be performed as soon as possible to confirm the findings 13 .…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil

Reis

Miranda

Afonso

et al. 2021

Rev. Inst. Med. trop. S. Paulo

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Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses that are well-known agents of keratitis, anterior uveitis, scleritis and retinitis. CMV is usually associated with ocular diseases in immunosuppressed individuals, with a notable exception of hypertensive anterior uveitis with distinctive clinical features in immunocompetent patients. This syndrome was characterized in the last two decades in Europe and Southeast Asia, and then documented in the rest of world. Definitive diagnosis in these cases is usually made by Polymerase Chain Reaction (PCR) of the anterior chamber fluid. We report three immunocompetent Brazilian adults with history of multiple glaucomatocyclitic crises and presenting with chronic hypertensive anterior uveitis invariably with mild anterior chamber inflammation and characteristic scarce nummular keratic precipitates. CMV DNA was successfully amplified and detected in the aqueous humor of all patients. Corneal endothelial counts were significantly reduced in the involved eyes, with one patient developing bullous keratopathy. All patients were then treated with topical ganciclovir gel and corticosteroids, with subsequent control of the intraocular inflammation. CMV may represent an overlooked / underestimated etiology of hypertensive anterior uveitis that may progressively lead to endothelial dysfunction, culminating in bullous keratopathy. Management of patients is challenging, with the potential use of topical antivirals to decrease the number of relapses, and corticosteroids to control anterior uveitis / endotheliitis and to protect the corneal endothelium.

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“…Post-keratoplasty CMV corneal infection remains a significant complication [ 5 ], elevating graft failure rate to > 70% [ 6 ]. CMV infection causes corneal graft failure which leads to repeated penetrating keratoplasty (PKP) [ 7 , 8 ]; however, data detailing graft failure rates and clinical features of patients with CMV infection undergoing repeat keratoplasty remain insufficient.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Cytomegalovirus Infection After Repeat Keratoplasty and Associated Rate of Graft Failure

Zang,

Zhao,

Peng

et al. 2024

Ophthalmol Ther

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Introduction The aim of this work was to compare the prognosis and characteristics of patients with Cytomegalovirus (CMV) infection (CMV+) with those of patients without virus infection (Virus–) undergoing repeat keratoplasty. Methods This prospective propensity score-matched cohort study enrolled patients who underwent repeat keratoplasty for graft failure at the Peking University Third Hospital between January 2016 and May 2022. Patients with prior viral keratitis before the first keratoplasty were excluded. The primary outcome measure was the graft failure rate. The secondary outcome measures included the anterior segment characteristics, intraocular pressure (IOP), and endothelial cell density. Results Ninety-four matched patient pairs were included. The graft failure rate in the CMV+ group (71%) was higher than that in the Virus– group (29%) ( P < 0.001). CMV infection in the cornea increased the risk of repeat graft failure and shortened the median survival time (hazard ratio, 3.876; 95% confidence intervals, 2.554–5.884; P < 0.001). The characteristics of graft failure included exacerbation of ocular surface inflammation, neovascularization, and opacification. Epithelial defects, high IOP, and endothelial decompensation were observed at an increased frequency in the CMV+ group (all P < 0.005). Recurrent CMV infection presented as early endothelial infection in the CMV+ group. Recurrence of CMV infection was confined to the graft endothelium without involving the stroma and epithelium post-repeat endothelial keratoplasty. Conclusions CMV infection post-keratoplasty leads to persistent endothelial damage and graft opacification and significantly increases the risk of repeat graft failure. Localized recurrence of CMV infection in the endothelial grafts underscores the importance of monitoring and treatment. Trial Registration Chictr.org.cn, ChiCTR1800014684. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-024-00968-1.

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Descemet Stripping Automated Endothelial Keratoplasty Outcomes in Patients With Cytomegalovirus Endotheliitis

Cited by 18 publications

References 21 publications

Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach

Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach

Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil

Incidence of Cytomegalovirus Infection After Repeat Keratoplasty and Associated Rate of Graft Failure

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