Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis: Clinical Features
Cytomegalovirus (CMV), a member of the human herpesvirus family, often causes recurrent ocular inflammation of the anterior segment in immunocompetent patients, including corneal endotheliitis, iris atrophy, and anterior uveitis.
CMV corneal endotheliitis characterized by corneal edema, linear or circular keratic precipitates (KPs), and mild anterior chamber reaction. It sometimes accompanies intraocular pressure (IOP) elevation. Polymerase chain reaction (PCR) of aqueous humor samples is helpful in confirming the diagnosis. Previous studies have demonstrated the efficacy of treatment with topical ganciclovir (GCV) and systemic anti-CMV agent. In some cases, endothelial decompensation occurs, that may require endothelial keratoplasty. Also, persistent IOP elevation require glaucoma surgery.
The purpose of this study by Mori et al was to highlight manifestations of glaucoma associated with CMV corneal endotheliitis. They paid special attention to glaucoma status, including the onset of glaucoma, glaucoma in the fellow eye, visual field defects, intraocular pressure, and final outcomes. Case series revealed that most of the patients with CMV corneal endotheliitis had glaucoma.
Authors reviewed the 34 patients that met the diagnostic criteria for CMV endotheliitis in hospital, with special attention to the glaucoma status, including onset of glaucoma, glaucoma in the fellow eye, visual field defects, intraocular pressure, and final outcomes.
- Thirty-four eyes of 34 patients with CMV corneal endothelitis were enrolled.
- Thirty-two eyes (94.1%) had a history of a glaucoma diagnosis, which had been treated for 10.0 ± 10.1 years.
- Glaucoma in the fellow eye was noted in 16 cases (47.1%) and a history of Posner-Schlossman syndrome was noted in 13 cases (38.2%).
- Visual fields measured using a Humphrey field analyzer were normal-to-early stage (MD>-6dB) in 16 eyes (47.1%) and middle-to-late stage (MD≤-6dB) in 18 eyes (52.9%).
- The intraocular pressure decreased from 22.4 ± 10.6 mmHg at the initial visit to 14.9 ± 7.9 mmHg after medical treatment, including 0.5% topical ganciclovir (GCV) with and without a systemic anti-CMV agent, corticosteroid eye drops, and an anti-glaucoma agent (p<0.01). During the follow-up period of 4.8 ± 3.0 years (range, 0.2–10 years), 16 eyes (47.1%) required glaucoma surgery, including filtering surgery (7 eyes) and trabeculotomy only (9 eyes).><0.01).
- During the follow-up period of 4.8 ± 3.0 years (range, 0.2–10 years), 16 eyes (47.1%) required glaucoma surgery, including filtering surgery (7 eyes) and trabeculotomy only (9 eyes).
"In conclusion, our case series revealed that most of the patients with CMV corneal endotheliitis had glaucoma. Although medical therapy, including 0.5% topical GCV, was effective in reducing the IOP, one-half of the patients required glaucoma surgery. Therefore, ophthalmologists should strive to establish a timely diagnosis of CMV corneal endotheliitis by PCR testing of aqueous humor samples to prevent sight-threatening glaucomatous damage."
Source: Mori et al; Clinical Ophthalmology 2022:16
https://doi.org/10.2147/OPTH.S376039
