title: The effect of topical application of 0.15% ganciclovir gel on cytomegalovirus corneal endotheliitis.
abstract: The aim of this study was to evaluate the therapeutic efficacy and drug transfer of topical application of 0.15% ganciclovir (GCV) gel on cytomegalovirus (CMV) corneal endotheliitis.
  
  
  
  This study is a multicentre, prospective, interventional case series. Seven eyes of seven immunocompetent patients diagnosed with CMV corneal endotheliitis, based on clinical manifestations and qualitative PCR, were enrolled in this study. The patients were treated with topical applications of 0.15% GCV gel six times daily for 12 weeks without concomitant systemic GCV. Clinical evaluations and quantitative PCR of CMV were performed, and GCV concentrations in aqueous humour were measured by liquid chromatography/tandem mass spectrometry.
  
  
  
  Clinical improvement of coin-shaped lesions, other types of keratic precipitates, corneal oedema, and anterior chamber inflammation was confirmed at the 4-week visit in all seven eyes. The GCV treatment significantly decreased the CMV copy numbers (p<0.0001). After 12 weeks of treatment, six eyes recovered clear corneas with good vision, and endothelial function was well maintained. Detectable levels of GCV were confirmed in the aqueous humour of all the eyes. The mean GCV concentration in the anterior chamber was 162.0±202.4 ng/mL. The re-emergence of CMV without symptoms was observed in one eye with lower drug transfer. No side effects were observed.
  
  
  
  Clinical improvement and reduced CMV copy numbers in the aqueous humour were confirmed in the CMV corneal endotheliitis cases. Although the case numbers are limited and long-term follow-up is necessary, the topical application of 0.15% GCV gel appears to be a useful treatment option for CMV endotheliitis.
  
  
  
  UMIN000012435.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.|Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyoto, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Koizumi
authors.affiliation: Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Tottori, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Miyazaki
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Tottori, Japan.
authors.forename: Fumie
authors.initials: F
authors.lastname: Ohtani
authors.affiliation: Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Tottori, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Kandori-Inoue
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Horikiri
authors.affiliation: Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ueta
authors.affiliation: Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Tottori, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000008:administration & dosage*; D001082:Aqueous Humor / Q000821:virology; D015715:Corneal Edema / Q000175:diagnosis; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000188:drug therapy* / Q000821:virology; D015774:Ganciclovir / Q000008:administration & dosage*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D014792:Visual Acuity
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D009883:Ophthalmic Solutions; D015774:Ganciclovir
keywords: Cornea; Infection; Treatment Medical