Cytomegalovirus - early diagnois is crucial

Early diagnosis remains crucial in preventing loss of endothelial cells and unnecessary treatment resulting from misdiagnosis in patients with cytomegalovirus (CMV)-induced corneal endotheliitis, according to a recent study.

“Our research highlights the effectiveness of antiviral treatment for CMV endotheliitis, but further study is needed to establish treatment regimens for the disease in order to prevent corneal endothelial dysfunction,†reported Noriko Koizumi MD, PhD at the 2015 Congress of the European Society of Ophthalmology (SOE) in Vienna, Austria.

CMV endotheliitis was first reported by Prof Koizumi and her colleagues in 2006. Recently, attention has been focused on CMV as an etiologic factor of anterior segment inflammation in immunocompetent individuals.

While CMV endotheliitis is recognised as the most common virus implicated in corneal endotheliitis, diagnostic criteria and a standardised treatment protocol have yet to be established, said Prof Koizumi, Professor, Doshisha University/Kyoto Prefectural University of Medicine, Japan.

Nevertheless, much progress has been made thanks to the Japan Corneal Endotheliitis Study Group, which proposed diagnostic criteria for CMV endotheliitis based on a viral examination by PCR of aqueous humour in combination with clinical manifestations. A national survey was then retrospectively conducted among 1,160 members of the Japan Cornea Society to review the patient profiles, clinical manifestations, and treatment modalities of individuals who met the diagnostic criteria for CMV endotheliitis. “To the best of our knowledge, this is the largest case series of CMV endotheliitis to report the comprehensive clinical features of this newly identified infectious corneal disease,†said Prof Koizumi.

The study included 109 eyes of 106 patients from 30 different clinics and centres in Japan, with 79 diagnosed as typical CMV endotheliitis and 30 as atypical CMV endotheliitis. The mean patient age was 66.9 years, with 85 males (80.2 per cent) and 21 females (19.8 per cent) identified.

Patients were commonly diagnosed with anterior uveitis and ocular hypertension prior to confirmation of CMV endotheliitis. Coin-shaped lesions were observed in 70.6 per cent, and linear keratic precipitates in 8.3 per cent of the patients, respectively. In terms of treatment, anti-CMV drugs were administered in 95 per cent of cases, said Prof Koizumi.

The effect of anti-CMV treatment was clinically evaluated one month after initiation of anti-CMV treatment in 96 eyes. While combined systemic and topical anti-CMV therapy was found to be more effective than systemic or topical anti-CMV treatment alone, the difference was non-significant, said Prof Koizumi.

Noriko Koizumi: nkoizumi@mail.doshisha.ac.jp

Study reference: Koizumi N et al. British Journal of Ophthalmol 2015;99(1):54-58