Corneal Endothelial Cell Density of Cytomegalovirus Corneal Endotheliitis Cases

Abstract

Purpose : Corneal endotheliitis causes specific inflammation of the corneal endothelium, resulting in severe visual impairment due to dysfunction of the corneal endothelium, and cytomegalovirus (CMV) is recognized as the most common causative pathogen of corneal endotheliitis in immunocompromised individuals. Reportedly, systemic and topical administration of antivirals such as ganciclovir (GCV) is reportedly beneficial, but a standard treatment protocol has yet to be established. The purpose of this retrospective study was to examine the change of corneal endothelial cell density (ECD) post treatment in patients with CMV-related corneal endotheliitis.

Methods : In this retrospective study, we reviewed the records of CMV-related corneal endotheliitis cases seen at our hospital between July 2013 and March 2022 with no history of intraocular surgery that directly affects ECD at diagnosis. Patient demographics, clinical history, and ECD were examined.

Results : Eighteen eyes of 18 cases (13 males, 5 females; mean age: 61.5±15.0 years; mean follow-up period: 57.2±33.7 months) diagnosed with CMV-related corneal endotheliitis with no history of intraocular surgery were enrolled. All cases had a history of anterior uveitis. Mean ECD was 1442±579 cells/mm² in the CMV corneal endotheliitis eyes and 2690±229 cells/mm² in the fellow eyes, thus illustrating a significant difference (p<0.001) between them, except in 2 cases in which corneal edema prevented ECD measurement. Of the 18 cases, there was no recurrence of corneal endotheliitis in the 10 cases that underwent combined topical and systemic GCV treatment, while recurrence did occur in 2 (25%) of the 8 cases that underwent only topical GCV treatment. During the follow-up period, the cornea remained clear in 16 eyes, yet 2 eyes required endothelial keratoplasty. Mean ECD loss was 6.4±11.3% in the patients with no intraocular surgery within the follow-up period and 40.3±34.9% in the patients who did undergo intraocular surgery, thus illustrating a significant difference (p<0.05) between them.

Conclusions : Our findings revealed that systemic and topical antiviral therapy after diagnosis of CMV-related corneal endotheliitis, followed by continued topical antiviral therapy, reduces recurrence of endotheliitis and maintains ECD.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.