title: Topical ganciclovir treatment in patients with cytomegalovirus endotheliitis receiving penetrating keratoplasty.
abstract: BACKGROUND
  To report seven cases diagnosed as cytomegalovirus endotheliitis and treated with topical 2% ganciclovir following penetrating keratoplasty.
  
  
  METHODS
  A retrospectively comparative case series.
  
  
  METHODS
  A retrospective interventional case series, including seven eyes of seven patients with cytomegalovirus endotheliitis after penetrating keratoplasty.
  
  
  METHODS
  Clinical and immunological characteristics were studied in seven penetrating keratoplasty cases with positive quantitative polymerase chain reaction results for cytomegalovirus DNA from aqueous taps and treated with topical 2% ganciclovir.
  
  
  METHODS
  Clinical features and responses to topical 2% ganciclovir.
  
  
  RESULTS
  Seven immunocompetent patients experienced acute anterior inflammation with graft oedema and pigmented keratic precipitates after penetrating keratoplasty. Their immunological profiles showed immunoglobulin G cytomegalovirus (+) and immunoglobulin M cytomegalovirus (-) in all cases. Topical 2% ganciclovir was prescribed every 2 to 3 h daily as induction therapy and every 4 h as long-term maintenance therapy. All cases had undetectable cytomegalovirus DNA after follow-up aqueous taps. Topical 2% ganciclovir preserved endothelium of cytomegalovirus-infected grafts at early stage and also provided a steady anticytomegalovirus environment for further regrafting in failed grafts at late stage. Acute inflammation reactivated in two cases and was suppressible by steroid under topical ganciclovir. No delayed re-epithelialization and any toxicity were observed. To date, no case treated in this way had displayed cytomegalovirus recurrence.
  
  
  CONCLUSIONS
  Continuous topical 2% ganciclovir and a topical steroid adjusted by anterior inflammation are suggested after penetrating keratoplasty in all cases with cytomegalovirus endotheliitis to prevent cytomegalovirus recurrence.
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chien-Chia
authors.initials: CC
authors.lastname: Su
authors.forename: I-Jong
authors.initials: IJ
authors.lastname: Wang
authors.forename: Wei-Li
authors.initials: WL
authors.lastname: Chen
authors.forename: Chang-Pin
authors.initials: CP
authors.lastname: Lin
authors.forename: Brian
authors.initials: B
authors.lastname: His
authors.forename: Fung-Rong
authors.initials: FR
authors.lastname: Hu
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000821:virology; D002452:Cell Count; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D004728:Endothelium, Corneal / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D004797:Enzyme-Linked Immunosorbent Assay; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir