Intra-cameral level of ganciclovir gel, 0.15% following topical application for cytomegalovirus anterior segment infection: A pilot study

Waduthantri, Samanthila; Zhou, Lanlan; Chee, Soon-Phaik

doi:10.1371/journal.pone.0191850

Cited by 27 publications

(13 citation statements)

References 33 publications

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“…Waduthantri et al investigated the intracameral drug concentration after the use of topical ganciclovir in 23 eyes with CMV anterior uveitis and 6 eyes with CMV endotheliitis. After a 6-week application of topical ganciclovir 0.15% 5 times per day, the mean ganciclovir concentration in human aqueous humor was 17.4 ± 30.6 ng/mL, which is below the ID 50 for CMV replication [37].…”

Section: Intravenous Ganciclovir and Oral Valganciclovirmentioning

confidence: 78%

“…Its long intracellular half-life lasts over 24 h [41]. These factors may all contribute to the clinical effects of ganciclovir in CMV endotheliitis despite the suboptimal IC 50 [37]. Increasing the frequency of application may increase its intracameral concentration but should be balanced with compliance and ocular surface toxicity.…”

Section: Intravenous Ganciclovir and Oral Valganciclovirmentioning

confidence: 99%

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Management of cytomegalovirus corneal endotheliitis

et al. 2021

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Background Cytomegalovirus (CMV) can manifest as corneal endotheliitis in immunocompetent individuals. Early diagnosis is prudent to prevent endothelial cell loss, which could ultimately lead to corneal decompensation. CMV DNA was first detected in an eye with corneal endotheliitis in 2006; since then, clinical evidence from numerous case reports and case series have accumulated. Main text In this narrative review, we identified several drugs, including ganciclovir, valganciclovir, and their combination in oral, intravenous, intravitreal, and topical forms in different concentrations, together with the judicious use of topical steroids, have reported variable success. There has yet to be any prospective comparative study evaluating the efficacy and safety of these assorted forms of treatment; clinical evidence is based on case reports and case series. CMV endotheliitis presenting with corneal edema can masquerade as other corneal diseases and thus poses a great challenge especially in post-keratoplasty eyes. Heightened awareness is needed before and after keratoplasty to start prompt prophylaxis and treatment. Conclusion There is no consensus on the management of CMV endotheliitis. Further studies are much needed to elucidate the optimal treatment modality, regime, and duration in the treatment and prophylaxis of CMV endotheliitis.

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Section: Intravenous Ganciclovir and Oral Valganciclovirmentioning

confidence: 78%

Section: Intravenous Ganciclovir and Oral Valganciclovirmentioning

confidence: 99%

Management of cytomegalovirus corneal endotheliitis

et al. 2021

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“…A recent study reported that ganciclovir levels in the AH were below the 50% inhibitory dose (ID 50 ) for HCMV replication, following topical application of ganciclovir gel 0.15%. 49 The preferential concentration of the ganciclovir gel in solid ocular tissue can explain the clinical improvement seen in these eyes, and this form of ganciclovir therapy seems to be tolerated. The treatment option, topical 2% ganciclovir solution as induction and maintenance treatment for CMV iritis, is gaining attention recently.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients

Leleu

Jhanji

Touhami

et al. 2019

Ocular Immunology and Inflammation

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To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin. Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc. Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir. Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients.

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“…We analyzed this group separately and found that the timing of disease onset was no different statistically compared to patients with disease in one eye only. Topical ganciclovir 0.15% has been shown to be useful in the treatment of CMV endotheliitis, 34,35 reducing CMV viral load in the aqueous. It has also been reported to be effective in treating herpes keratitis.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of New Onset Endotheliitis After Cataract Surgery

Wang

Zheng

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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The purpose of this study was to report the characteristics of new-onset endotheliitis after cataract surgery and to identify contributing risk factors. METHODS. In this single-center study, we retrospectively reviewed the clinical records of all patients who underwent uneventful cataract surgery in the Eye Hospital of Wenzhou Medical University between January 2015 and December 2016. Postoperative endotheliitis cases were identified by screening of keywords and individually verified by a cornea specialist. Endotheliitis rates and 95% confidence intervals (CI) were calculated. Cox proportional hazard regression analysis was used to investigate the association between endotheliitis and associated factors. RESULTS. A total of 20,743 cataract surgeries were performed. Fifty-nine eyes developed endotheliitis after cataract surgery, with an incidence of 0.28%. The mean interval between surgery and first record of endotheliitis was 24.51 6 9.50 days (range, 5 to 45 days); 45 (76.27%) cases of endotheliitis developed within 30 days. The multiadjusted hazard ratio (HR) associated with increased risk of endotheliitis was 16.1 (95% CI, 3.9 to 66.9; P < 0.001) for patients 76 years of age or older and 10.2 (95% CI, 2.4 to 43.2; P ¼ 0.002) for those 66 to 75 years of age compared with those 65 years of age or younger. Endotheliitis was also associated with history of diabetes mellitus (HR, 1.9; 95% CI, 1.1 to 3.2; P ¼ 0.026). CONCLUSIONS. This study found the incidence of endotheliitis after cataract surgery to be 0.28%. Diabetes mellitus and old age are major risk factors for developing endotheliitis.

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Intra-cameral level of ganciclovir gel, 0.15% following topical application for cytomegalovirus anterior segment infection: A pilot study

Cited by 27 publications

References 33 publications

Management of cytomegalovirus corneal endotheliitis

Management of cytomegalovirus corneal endotheliitis

Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients

Incidence and Risk Factors of New Onset Endotheliitis After Cataract Surgery

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