Topical ganciclovir treatment post-Descemet’s stripping automated endothelial keratoplasty for patients with bullous keratopathy induced by cytomegalovirus

Kitazawa, Koji; Jongkhajornpong, Passara; Inatomi, Tsutomu; Koizumi, Noriko; Kayukawa, Kanae; Wakimasu, Koichi; Sotozono, Chie; Kinoshita, Shigeru

doi:10.1136/bjophthalmol-2017-311145

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Maintenance therapy with 0.5% topical GCV could be used due to the inhibition of CMV activity, facilitating IOP control, and preserving the corneal endothelium. 18 , 19 In addition, topical GCV induces less frequent adverse events than systemic GCV, such as neutrocytopenia. 5 The clinical effect of 0.15% GCV ophthalmic gel, which is approved for HSV keratitis, has been suggested in some case series even though 0.15% GCV ophthalmic gel has not been approved and marketed in Japan.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

Ye¹,

Yokogawa²,

Nishino³

et al. 2022

OPTH

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Purpose The purpose of this study was to highlight the manifestations of glaucoma associated with cytomegalovirus (CMV) corneal endotheliitis. Methods We reviewed the 34 patients that met the diagnostic criteria for CMV endotheliitis in our hospital, with special attention to the glaucoma status, including onset of glaucoma, glaucoma in the fellow eye, visual field defects, intraocular pressure, and final outcomes. Results Thirty-four eyes of 34 patients (mean age, 69.1 ± 13.1 years; 31 males [91.2%]) with CMV corneal endotheliitis were enrolled. Thirty-two eyes (94.1%) had a history of a glaucoma diagnosis, which had been treated for 10.0 ± 10.1 years. Glaucoma in the fellow eye was noted in 16 cases (47.1%) and a history of Posner-Schlossman syndrome was noted in 13 cases (38.2%). Visual fields measured using a Humphrey field analyzer were normal-to-early stage (MD>-6dB) in 16 eyes (47.1%) and middle-to-late stage (MD≤-6dB) in 18 eyes (52.9%). The intraocular pressure decreased from 22.4 ± 10.6 mmHg at the initial visit to 14.9 ± 7.9 mmHg after medical treatment, including 0.5% topical ganciclovir (GCV) with and without a systemic anti-CMV agent, corticosteroid eye drops, and an anti-glaucoma agent (p<0.01). During the follow-up period of 4.8 ± 3.0 years (range, 0.2–10 years), 16 eyes (47.1%) required glaucoma surgery, including filtering surgery (7 eyes) and trabeculotomy only (9 eyes). Conclusion Our case series showed that most of the patients with CMV corneal endotheliitis had glaucoma. Although medical therapy, including 0.5% topical GCV, had efficacy in lowering the intraocular pressure, one-half of the cases required glaucoma surgery. Therefore, ophthalmologists should strive to make an earlier diagnosis of CMV corneal endotheliitis by utilizing PCR testing of aqueous humor samples to prevent sight-threatening glaucomatous damage.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

Ye¹,

Yokogawa²,

Nishino³

et al. 2022

OPTH

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“…Based on the higher rate of graft failure seen and the fact that all patients with graft failure were on antiviral therapy at the time of graft failure, we suspect that patients with a history of viral anterior uveitis might require higher doses of antiviral medications to achieve viral suppression. Recently, topical ganciclovir in CMV endotheliitis 18 and aggressive perioperative antiviral treatment with topical and oral agents have been advocated in patients undergoing endothelial keratoplasty for HSV endotheliitis. 19 However, the ideal antiviral therapy regimen remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Keratoplasty Outcomes in Patients With Uveitis

Hennein

Lambert

Chamberlain

et al. 2020

Cornea

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To examine the corneal transplant failure rates and associations with uveitic eye disease. Methods:The retrospective chart review identified 70 eyes from 42 patients with uveitis that underwent 40 primary transplants and 30 repeat transplants at 2 major academic centers over a 9-year period. The graft failure rate was calculated. Variables hypothesized to be associated with graft failure were analyzed as covariates using a Cox proportional hazards analysis clustered by the patients to determine their association with failure rates.Results: Of the 70 grafts, the mean duration of follow-up for patients was 40.6 months (range 4-90 months) and the median survival time was 24.1 months (interquartile range of 9-290 months). Twenty-two patients (52%) had graft failure. There was a higher rate of graft failure in patients with infectious uveitis as compared to those with noninfectious uveitis (hazard ratio 2.46, P = 0.031). Patients with successful grafts had their inflammation controlled for a longer period of time before transplantation as compared to those with failed grafts (38.6 vs. 13.6 months, P = 0.004). Worse preoperative visual acuities were significantly associated with graft failure (P , 0.001). Conclusions:There is limited knowledge of corneal transplant outcomes in uveitic patients in the current literature. In our study, over half of the grafts failed. Infectious uveitis (especially viral) was a strong predictor of graft failure. A shorter period of inflammation control before transplantation, previously failed grafts, and worse preoperative visual acuity were also associated with graft failure.

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“…Topical ganciclovir 0.5% eye drops Kitazawa et al reported favorable outcomes for long term use of topical ganciclovir 0.5% eye drops as prophylaxis in 6 eyes undergoing DSAEK [68]. Before DSAEK, all CMVpositive eyes were treated with 2-week systemic ganciclovir 5 mg/kg twice daily, topical ganciclovir 0.15% 4 to 8 times daily and fluorometholone 0.1% 2 to 4 times daily.…”

Section: Anti-cmv Prophylaxis After Keratoplastymentioning

confidence: 99%

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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Topical ganciclovir treatment post-Descemet’s stripping automated endothelial keratoplasty for patients with bullous keratopathy induced by cytomegalovirus

Abstract: UMIN000026746.

Cited by 11 publications

References 24 publications

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

Keratoplasty Outcomes in Patients With Uveitis

Management of cytomegalovirus corneal endotheliitis

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