Optimising graft survival in endothelial keratoplasty for endothelial failure secondary to cytomegalovirus endotheliitis

• Main Authors: Milton C. Chew, Donald T. Tan, Soon-Phaik Chee, Lim Li
• Format: Article
• Language: English
• Published: SpringerOpen 2019-08-01
• Series: Journal of Ophthalmic Inflammation and Infection
• Subjects: Cytomegalovirus endotheliitis; Endothelial failure; Descemet stripping automated endothelial keratoplasty, Aqueous polymerase chain reaction
• Online Access: http://link.springer.com/article/10.1186/s12348-019-0180-0

Abstract Background There is limited information regarding Descemet stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to cytomegalovirus (CMV) endotheliitis. Treatment is difficult with high recurrence rates. We describe a case when systemic valganciclovir therapy is directed by aqueous CMV-DNA levels, leading to good graft survival. Findings A 59-year-old male with bilateral CMV endotheliitis despite antiviral therapy developed endothelial failure and underwent DSAEK. Prior to surgery, aqueous polymerase chain reaction (PCR) for CMV was repeatedly performed, where CMV-positive episodes were treated with systemic valganciclovir. Monthly aqueous analysis was performed until CMV-DNA was undetectable before DSAEK was performed. Post-operative prophylactic systemic valganciclovir treatment was instituted and switched to topical valganciclovir treatment when aqueous samples were negative for CMV. Conclusion Targeted aqueous sampling for CMV-DNA perioperatively guides antiviral therapy and ensures adequacy of treatment, minimising the duration of systemic valganciclovir therapy to reduce adverse effects of long-term treatment.