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Tsutomu Inatomi, Noriko Koizumi, Yuichi Ohashi, Yoshitsugu Inoue, Manabu Mochizuki, Kohji Nishida, ; Clinical Manifestation and Effect of Ganciclovir Therapy for Cytomegalovirus Corneal Endotheliitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1683.
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© ARVO (1962-2015); The Authors (2016-present)
To report the findings of an epidemiological survey conducted in Japan regarding the clinical manifestations and the effect of ganciclovir antiviral therapy for the treatment of patients with cytomegalovirus (CMV) corneal endotheliitis.
An epidemiological survey was conducted in Japan and the clinical manifestations of 109 eyes of 106 cases diagnosed as CMV corneal endotheliitis were analyzed retrospectively. Prospective, multicenter clinical treatment was performed for 7 eyes of 7 cases. The mean patient age was 67.4±10.4 years, and the mean follow-up period was 12 months. The combined therapy of systemic ganciclovir (5mg/kg, 2 times daily) with topical 0.5% ganciclovir instillation was applied for 2 weeks following the tapering of topical instillation. Clinical evaluation was performed by use of real-time polymerase chain reaction (PCR) and slit-lamp examination.
Of the total 106 cases, 85 cases (80.2%) were male and 21 cases (19.8%) were female. Coin-shaped lesions and linear keratic precipitates (KPs) were observed in 70.6% and 8.3% of the cases, respectively. Clinical manifestations included corneal edema (73.4%), endothelial loss (81.7%), iritis (67.9%), and elevation of intraocular pressure (66.1%). In the prospective study, the average CMV viral load in aqueous humor before treatment was 8.55x104 copies/ml (range: 8.3x102 - 1.55x105 copies/ml). Coin-shaped lesions or linear KPs were detected in 100% and 29% of the cases, respectively, and 85.7% of the cases showed sustained virologic response after the initial combined therapy. All cases showed negative by PCR with additional topical ganciclovir therapy, but 3 cases (42.8%) showed the elevation of intraocular pression and 1 case (14.5%) showed the recurrence. Mean endothelial cell density (CED) (cell/mm2 ) at before and 1-month post treatment was 1160±365 and 1048±440, respectively. No significant reduction of CED and no adverse effects were observed.
Corneal endotheliitis with coin-shaped lesions or linear KPs, similar to the clinical rejection line, are major clinical manifestations in CMV corneal endotheliitis. The combined therapy of systemic and topical ganciclovir instillation is safe and effective for the treatment of patients with CMV corneal endotheliitis.
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