Relationships between the clinical characteristics and copy numbers of DNA of cytomegalovirus determined by real-time PCR

Abstract

Purpose To determine whether there is a correlation between the clinicals characteristics including various types of keratic precipitates and the copy numbers of the DNA of cytomegalovirus (CMV) in eyes with CMV corneal endotheliitis. Methods We reviewed the medical charts of four cases of corneal endotheliitis that were CMV-positive. We have classified types of clinical phenomenon into four types: coin-shaped KPs, sectoral corneal edema with or without Khodadoust line-like KPs, mutton-fat KPs, and fine KPs and have graded their severity. We also determined the copy numbers of the DNA of CMV in the aqueous humor by real-time polymerase chain reaction before and during the treatment. We evaluated the correlation between the patterns of clinical characteristics and copy number of the DNA of CMV. Results There were clinical improvements in all eyes following topical ganciclovir in conjunction with low dose of topical steroid treatment, with or without oral valganciclovir. The clinical characteristics and the copy numbers of the DNA of CMV varied during the treatment period. The presence of coin-shaped KPs was correlated with high copy numbers (105–103 copies/ml) of the DNA of CMV. The copy numbers of the DNA of CMV with sectoral corneal edema with or without Khodadoust line-like KPs ranged from 104 to 102 copies/ml, and it was occasionally accompanied by high intraocular pressure. Mutton-fat KPs were observed inferiorly, sometimes together with coin-shaped KPs and sectoral corneal edema, or solely. The copy numbers in eyes with mutton-fat KPs varied and occasionally less than the cutoff level. Fine-pigmented KPs were observed after the resolution of the endotheliitis, and no DNA of CMV was detected in the aqueous humor. Conclusions Careful observations of the clinical characteristics such as the KPs and corneal edema might be helpful in estimating the amount of the DNA of CMV in eyes with corneal endotheliitis.

Management of cytomegalovirus corneal endotheliitis

“…The authors recommended that combined topical steroid with antiviral therapy might be indicated in CMV endotheliitis with sectoral corneal edema with and without Khodadoust line-like KPs and mutton-fat KPs. Where antiviral treatment alone could suffice in eyes with coin-shaped KPs [ 70 ], topical steroids should be used judiciously in the treatment and maintenance of CMV endotheliitis and the IOP must be monitored.…”

The Analysis of Dynamic Changes and Prognosis of Posner–Schlossman Syndrome with Cytomegalovirus Infection and Antiviral Therapy

“…We classified KPs into three types mostly observed in PSS under a slit lamp [20,21]. We found different KP patterns changed differently during PSS prognosis, and disappearance of specific KPs was correlated with the treatment period.…”

“…Resulted from immune reaction [20], high percent of mutton-fat KP presence indicates severe fresh attack. Pigmented KP is more a sign of historical attack, which is harder to eliminate completely.…”

Destructive effects on endothelial cells of grafts in cytomegalovirus DNA-positive patients after keratoplasty

“…Moreover, a significant difference in graft ECD between the CMV+ and virus-groups appeared earlier in the PKP subgroup than in the DSAEK subgroup (6mo after PKP vs 12mo after DSAEK), suggesting that CMV replication had a shorter cycle in eyes that underwent PKP, which may be related to a stronger immunosuppressive effect of PKP on the anterior segment [20] . Previous studies found that anterior-segment CMV infections could occur after PKP [10,21] , DSAEK [22][23] , and Descemet's membrane endothelial keratoplasty (DMEK) [18] , but were most common following the PKP procedure. Yoshimura et al [21] first reported a case of CMV positivity after multiple PKP procedures.…”

“…Previous studies found that anterior-segment CMV infections could occur after PKP [10,21] , DSAEK [22][23] , and Descemet's membrane endothelial keratoplasty (DMEK) [18] , but were most common following the PKP procedure. Yoshimura et al [21] first reported a case of CMV positivity after multiple PKP procedures. Chee et al [24] reviewed patients who underwent PKP and developed postoperative CMV positivity that manifested as pigmented keratoplasty, corneal neovascularization, and Descemet's folds.…”