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Clinical case of simultaneous Involvement of the cornea in the form of consequences of cytomegalovirus keratoiridocyclitis and adenoviral keratoconjunctivitis.

Poster Details

First Author: O.Vasilyeva RUSSIA

Co Author(s):    D. Maychuk   A. Svetlana           

Abstract Details

Purpose:

To study features of the clinical course and response to combined therapy in the patient with simultaneous involvement of the cornea in the form of consequences of cytomegalovirus (CMV) keratoiridocyclitis and adenoviral keratoconjunctivitis (AVKC).

Setting:

S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia

Methods:

The patient G., 26 years old. Diagnosis: OD–Consequences of keratoiridocyclitis, OU–Postadenoviral corneal infiltrates. The patient suffered keratoiridocyclitis of the right eye 3 months ago and AVKC upon completion of keratoiridocyclitis. At the time of examination: VisOD=0,4sph–0,5D=0,6; OS=0,9. Objectively: OD–central rounded corneal opacity (d=3.5 mm). From 6 to 12 hours–peripheral arcuate stromal opacity. Single old precipitates were on the endothelium. OU–subepithelial postadenoviral corneal infiltrates (OD–30, OS–10 ones). Enzyme immunoassay of blood: antibodies against Herpes simplex, Toxopl.gondii, Chl.trachomatis weren’t detected; anti-CMV IgG antibodies were found in titer of 1:800. There was negative result of adenoviral DNA detection by PCR in conjunctival smears. The treatment included: -Dexamethasone 0.1%, 0.02%, 0.01% eye drops by decreasing the scheme for 12weeks -Cyclosporine 0.05%eye drops twice a day for 9months -Artificial tears -Every three months – a course of anti-CMV therapy (Ganciclovir eye gel 0.15% for 21days, oral Valacyclovir 1000mg for 5days). Results after one year period: -both eyes: resorption of postadenoviral corneal infiltrates; -right eye: resorption of the central opacity and precipitates; incomplete resorption of arcuate peripheral stromal infiltrate -there weren’t marked signs of CMV relapse process -VisOD=1.0; OS=1.0 -IOP data was normal throughout the treatment

Results:

Long-term anti-inflammatory therapy with Cyclosporine 0.05% in patient with simultaneous involvement of the cornea in the form of consequences of cytomegalovirus keratoiridocyclitis and AVKC allowed achieving full resorption of corneal opacities. According to the results of PCR the absence of adenovirus in conjunctival smears indirectly testifies about autoimmune nature of re-development of postadenoviral corneal infiltrates in the remote period of the disease. Thus postadenoviral infiltrates in the patient required only anti-inflammatory and resolving treatment. Considering the results of the enzyme immunoassay of blood, namely the titers of anti-CMV Ig G and absence of antibodies against other pathogens, as well as the clinical picture and history, we can talk about the cytomegalovirus as a primary reason for the development of keratoiridocyclitis of the right eye. Furthermore, the absence of the acute-phase anti-CMV Ig M antibodies indicates the chronic course of the process. Accordingly, the use of a regular course of antiviral therapy over a long period was justified. It allowed maintaining the patient's condition stable, without signs of recurrence of primary cytomegalovirus process, despite the use of a long-term resolving immunosuppressive therapy.

Conclusions:

-

Financial Disclosure:

NONE

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