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DSAEK outcomes in patients with cytomegalovirus keratouveitis

Poster Details

First Author: E.Fernández López AUSTRALIA

Co Author(s):    E. Chan   G. Cleary   M. Daniell              

Abstract Details

Purpose:

There is currently limited information regarding the outcomes of DSAEK in eyes with a history of cytometalovirus (CMV) keratouveitis. The purpose of this paper is to report the postoperative course of four eyes which underwent multiple DSAEK for endothelial failure secondary to CMV.

Setting:

Cornea Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Methods:

Retrospective review of the medical records of four eyes of four patients with a history of CMV keratouveitis and DSAEK. CMV was confirmed in each case by a positive aqueous tap for CMV on quantitative polymerase chain reaction (PCR). The clinical characteristics of the patients and postoperative outcomes was studied.

Results:

The mean age of the four patients was 69.6±8.1 years. All patients were immunocompetent. Three eyes had been previously diagnosed with hypertensive uveitis and one eye with pseudophakic bullous keratopathy. Ten DSAEKs were performed in total in the four eyes. Five grafts were performed without any post-operative treatment with oral valganciclovir. All subsequently failed after a mean of 8.0±3.8 months. Five grafts were managed with oral valganciclovir after CMV was confirmed on aqueous tap - 2 grafts remain clear; 2 grafts failed after a mean of 28.5±13.4 months (p=0.02); 1 graft did not clear after 6 weeks (acute graft failure).

Conclusions:

The diagnosis of CMV keratouveitis and the postoperative management of DSAEK in these cases remains challenging. The post-operative course can be complicated by CMV reactivation, which may masquerade either as graft rejection or graft failure. Long term treatment with oral valganciclovir may decrease graft failure rates.

Financial Disclosure:

NONE

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