Clinical characteristics and treatment outcomes of cytomegalovirus anterior uveitis and endotheliitis: A systematic review and meta-analysis

Nora, Rina La Distia; Putera, Ikhwanuliman; Mayasari, Yuri Dwi; Hikmahwati, Wandya; Pertiwi, Adinda Mulya; Ridwan, Asri Salima; Sitompul, Ratna; Westcott, Mark; Chee, Soon-Phaik; Pavésio, Carlos; Thng, Zheng Xian; Gupta, Vishali; Agrawal, Rupesh

doi:10.1016/j.survophthal.2021.12.006

Cited by 23 publications

(26 citation statements)

References 55 publications

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“… 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. 20 , 21 …”

Section: Discussionmentioning

confidence: 99%

“… 4–9 In some cases, endothelial decompensation occurs, that may require endothelial keratoplasty. 4 , 5 Also, persist IOP elevation require glaucoma surgery. 4 , 5 , 11 …”

Section: Introductionmentioning

confidence: 99%

“…Cytomegalovirus (CMV), a member of the human herpesvirus family, often causes recurrent ocular inflammation of the anterior segment in immunocompetent patients, including corneal endotheliitis, iris atrophy, and anterior uveitis. [1][2][3][4][5][6] CMV corneal endotheliitis was initially recognized by 2 groups in 2006-2007. 2,3 Thereafter, CMV corneal endotheliitis has become an established clinical entity through series of reports from worldwide, mainly from Asian countries.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Thereafter, CMV corneal endotheliitis has become an established clinical entity through series of reports from worldwide, mainly from Asian countries. [1][2][3][4][5][6][7][8][9] CMV corneal endotheliitis characterized by corneal edema, linear or circular keratic precipitates (KPs), and mild anterior chamber reaction. It sometimes accompanies intraocular pressure (IOP) elevation.…”

Section: Introductionmentioning

confidence: 99%

“…It sometimes accompanies intraocular pressure (IOP) elevation. [4][5][6][7][8][9] Polymerase chain reaction (PCR) of aqueous humor samples is helpful in confirming the diagnosis. Previous work has demonstrated the efficacy of treatment with topical ganciclovir (GCV) and systemic anti-CMV agent.…”

Section: Introductionmentioning

confidence: 99%

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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%

“… 4–9 In some cases, endothelial decompensation occurs, that may require endothelial keratoplasty. 4 , 5 Also, persist IOP elevation require glaucoma surgery. 4 , 5 , 11 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

Ye¹,

Yokogawa²,

Nishino³

et al. 2022

OPTH

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PCR testing for herpesviruses in aqueous humor samples from patients with and without clinical corneal endothelial graft rejection

Abu Dail,

Daas,

Flockerzi

et al. 2024

Journal of Medical Virology

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To compare prevalence of positive PCR tests for herpesviruses between patients with and without a history of clinical corneal endothelial allograft rejection (AGR). Retrospective cross‐sectional study with two‐group comparison. A total of 307 aqueous humor (AH) samples from 235 Patients and 244 eyes who underwent penetrating keratoplasty or Descemet membrane endothelial keratoplasty or had a diagnostic AH aspiration due to clinical AGR between 2019 and 2023 were tested for DNA of herpes simplex virus (HSV), varicella‐zoster virus (VZV), cytomegalovirus (CMV), and Epstein‐Barr virus (EBV). PCR test results were compared between the two groups (with/without AGR). Another sub‐analysis examined the results of patients without a history of herpetic keratitis. A total of 8% of eyes with clinical AGR (9/108) had a positive PCR result for one of the herpesviruses (HSV:3, CMV:3, EBV:2, VZV:1). All patients in the group without AGR had negative PCR results for all previous viruses (0/136). The difference was statistically significant (p < 0.001). The sub‐analysis of eyes without a history of herpetic keratitis also revealed significantly more positive herpes PCR results (7/87) in eyes with AGR than in eyes without AGR (0/42, p = 0.005). Clinical AGR after keratoplasty shows a significant correlation to viral replication. Herpetic infection and AGR could occur simultaneously and act synergistically. Timely differentiation between active herpetic infection and/or AGR is pivotal for proper treatment and graft preservation.

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Red Eyes—Conjunctivitis, Corneal Ulcers, Dry Eye Disease, and Acute Uveitis

Gupta,

Bansal,

Sharma

et al. 2023

Ophthalmic Signs in Practice of Medicine

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Clinical characteristics and treatment outcomes of cytomegalovirus anterior uveitis and endotheliitis: A systematic review and meta-analysis

Cited by 23 publications

References 55 publications

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis

PCR testing for herpesviruses in aqueous humor samples from patients with and without clinical corneal endothelial graft rejection

Red Eyes—Conjunctivitis, Corneal Ulcers, Dry Eye Disease, and Acute Uveitis

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