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Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Yoshiaki Saito, Kazuhisa Sugiyama; Clinical features of glaucoma in cytomegalovirus corneal endotheliitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5779.
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© ARVO (1962-2015); The Authors (2016-present)
Recently, diagnostic criteria of cytomegalovirus (CMV) corneal endotheliitis was established by the Japan Corneal Endotheliitis Study Group. However, clinical features of ocular hypertension / secondary glaucoma associated with the disease had not been well understood. We performed a retrospective, observational clinical study to reveal manifestations of glaucoma associated with CMV corneal endotheliitis.
Eighteen eyes of 18 patients with CMV corneal endotheliitis (14 eyes with typical CMV endotheliitis and 4 eyes with atypical CMV endotheliitis) were enrolled this study. We analyzed the clinical manifestations highlighting the glaucoma status, including onset of glaucoma, fellow eye glaucoma, intraocular pressure, gonioscopic findings, visual field, and glaucoma surgery.
Mean age was 70.4±11.5 years. Seventeen cases (94.4%) were male. All 18 eyes had glaucoma history which had been treated for long duration (9.6±9.0 years). Eight eyes (44.4%) had been diagnosed as Posner-Schlosmann syndrome by previous ophthalmologist. Nine cases (50.0%) had the fellow eye glaucoma. All 18 eyes had received antiglaucoma agents and topical steroid treatment with (6 eyes) or without (12 eyes) aciclovir / valaciclovir. At initial visit, intraocular pressure was 21.5±10.9mmHg, and all sixteen eyes excluded 2 post-glaucoma surgery or keratoplasty eyes had open angle. Normal visual field or normal optic disc was noted in 5 eyes (27.8%), and visual field defects were early stage (MD>-6dB) in 4 eyes (22.2%), middle stage (-6dB>MD>-12dB) in 2 eyes (11.1%), and late stage (MD<-12dB, Kosaki classification) in 7 eyes (38.9%). After we made diagnosis of CMV corneal endotheliitis, we treated all cases with anti-CMV drug including systemic ganciclovir / valganciclovir, topical ganciclovir, and topical corticosteroids. Five eyes (27.8%) required glaucoma surgeries, including trabeculectomy (3 eyes), and 360-degree trabeculotomy (2 eyes).
All cases with CMV corneal endotheliitis had glaucoma history. In cases with refractory glaucoma due to Posner-Schlosmann syndrome or anterior uveitis, CMV corneal endotheliitis should be concerned as one of the differential diagnosis.
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