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Long-Term Topical Ganciclovir and Corticosteroids Preserve Corneal Endothelial Function in Cytomegalovirus Corneal Endotheliitis

Fan, Nai-Wen MD; Chung, Yu-Chien MD; Liu, Yao-Chung MD; Liu, Catherine Jui-Ling MD; Kuo, Yih-Shiuan MD; Lin, Pei-Yu MD

doi: 10.1097/ICO.0000000000000791
Clinical Science
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Purpose: To report the long-term outcomes of topical ganciclovir (GCV) and corticosteroids as a maintenance therapy for cytomegalovirus (CMV) corneal endotheliitis.

Methods: This retrospective study included 10 eyes of 9 patients diagnosed with CMV corneal endotheliitis with a minimum 1-year follow-up at a tertiary referral hospital between 2008 and 2014. CMV corneal endotheliitis was defined by corneal edema associated with typical keratic precipitates (KPs) and a positive CMV polymerase chain reaction from aqueous humor taps. Patients receiving long-term topical 0.5% GCV and topical corticosteroids without discontinuation were included. The final corneal condition and endothelial cell density (ECD) were reported.

Results: The mean age was 45.6 ± 11.7 years. The mean follow-up duration was 48 ± 25 months. All patients exhibited typical coin-shaped and/or linear KPs. A significant resolution of corneal edema and decreased KPs were achieved within 1 month in all patients after initiating topical 0.5% GCV every 2 hours and topical corticosteroids twice a day. The dose frequency was gradually tapered to GCV 4 times and corticosteroids once or twice a day as a maintenance therapy. All 10 eyes had a clear graft or corneas at the end of this study. The mean ECD was 1630 ± 699 cells per millimeter square before treatment and 1776 ± 834 cells per millimeter square at the end of the study period.

Conclusions: Topical 0.5% GCV and corticosteroids as a maintenance regimen without interruption effectively preserved long-term corneal endothelial function.

*Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan;

Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan;

National Yang-Ming University School of Medicine, Taipei, Taiwan;

§Department of Medicine of Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan; and

Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Reprints: Pei-Yu Lin, MD, Department of Ophthalmology, Taipei Veterans General Hospital, No. 201, Section 2 Shih-Pai Rd, Shih-Pai, Taipei 11217, Taiwan (e-mail: pylin@vghtpe.gov.tw).

Supported in part by grants from Taipei Veterans General Hospital (V104B-021).

The authors have no conflicts of interest to disclose.

Received July 12, 2015

Received in revised form November 27, 2015

Accepted January 08, 2016

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