ABSTRACT
Objective:To investigate the virological testing results of patients with corneal graft at the time of repeat keratoplasty and the diagnostic efficacy of multiple viral examinations.Methods:A case-control study was conducted.A total of 14 consecutive patients diagnosed with corneal graft failure were enrolled as graft failure group from March 2018 to December 2018 in Peking University Third Hospital, and 15 consecutive patients diagnosed with bullous keratopathy (BK) were enrolled as BK group in the meantime.All patients had unilateral involvement and indications for keratoplasty.Serum samples were collected from venous blood on the day of surgery, and specimens of aqueous humor and corneal tissue were obtained during corneal transplantation.Viral DNA in aqueous humor and corneal specimens was detected by real-time polymerase chain reaction (PCR).The level of viral antibodies in serum and aqueous humor was determined by enzyme-linked immunosorbent assay and the Goldmann-Witmer coefficient (GWC) was calculated.The tested viral species included herpes simplex virus (HSV), herpes zoster virus (VZV), and cytomegalovirus (CMV).For graft failure group, the relevance between elevated intraocular pressure, multiple previous keratoplasty surgeries, histories of viral keratitis and any positive result of viral analyses in this study were measured by the kappa consistency test.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University Third Hospital (No.2017299-02).Written informed consent was obtained from each subject.Results:At the time of keratoplasty, 9 out of 14 eyes in the graft failure group tested positive for at least one type of virus, with 6 eyes positive for CMV and 3 eyes positive for VZV.Positive aqueous humor PCR analysis detected VZV in 5 out of 14 eyes.Corneal tissue PCR analysis detected CMV in 5 out of 14 eyes.Positive GWC calculations detected CMV in 3 out of 10 eyes.The concordance between viral DNA and antibody detection was poor.All eyes in BK group were negative for the virological test, except for 2 eyes (2/15) with elevated aqueous humor GWC for CMV.The prevalence of viral infection was 64.2%(9/14) in graft failure group, which was significantly higher than 13.3%(2/15) in BK group ( P=0.014).In graft failure group, 7 eyes (7/14) had elevated intraocular pressure, 3 eyes (3/14) had multiple keratoplasty surgeries, and 6 eyes (6/14) had viral keratitis before this keratoplasty.However, none of these factors showed significant relevance with positive virological results (kappa=0.143, -0.155, -0.286). Conclusions:Viral infection has become a major cause of corneal graft failure.A combination of various virological analyses during keratoplasty can help to clarify the etiology and the viral infection status, and ultimately guide subsequent treatment.
ABSTRACT
Cytomegalovirus (CMV) is a primary pathogen causing corneal endotheliitis, which may necessitate corneal transplantation if corneal transparency can not be restored.Recurrence of CMV infection and immune rejection are the main causes of graft failure, emphasizing proper postoperative drug therapy to improve the prognosis of patients.Long-term use of antiviral medications is necessary in order to prevent viral recurrence for patients suffering from CMV corneal endotheliitis who have undergone corneal transplantations.When unexplained endothelial decompensation occurs after corneal transplantation, the diagnosis and treatment of CMV endotheliitis must be emphasized.Topical use of glucocorticoids is the main means to prevent immune rejection.Due to the lower incidence of rejection and increased risk of viral recurrence, reducing or even eliminating the use of immunosuppressants may be considered for patients receiving endothelial keratoplasty.In this paper, different antiviral and anti-rejection drug regimens for patients who have undergone corneal transplantation were reviewed to find more effective and reasonable regimens and provide references for clinical treatment.
ABSTRACT
@#The virus-related corneal endotheliitis has diverse inducement, complex etiology, unclear pathogenesis, diverse clinical manifestations. There is no unified classification at present. Auxiliary diagnosis technology is improving constantly, loop-mediated isothermal amplification and all kinds of PCR have a certain auxiliary role in the diagnosis of this disease. But the diagnosis also mainly relys on history and clinical manifestation in clinic. Anti-viral drug and glucocorticoid are the main treatment. Virus-related corneal endotheliitis has high recurrence rate, so there is an urgent need to research new drugs and new treatment. Experiment researches of genetic engineering drugs, such as vaccines, unwinding-primers enzyme inhibitors, and chemokine receptors, bring hope to the treatment of virus-related corneal endotheliitis. The purpose of this article is to review the related research of virus-related corneal endotheliitis.
ABSTRACT
·AIM: To observe the clinical effect and the changes of corneal endothelial morphology of glucocorticoid combined with antiviral therapy for viral corneal endotheliitis and evaluate the safety of this treatment. ·METHODS: The clinical data like predisposing factors, history and clinical manifestation were retrospectively analyzed, the 48 patients (48 eyes) with viral corneal dermatitis from January 2014 to December 2015 in Xi'an No.4 Hospital were included. A comparative study was conducted between affected eyes and healthy eyes. The cure rate, recurrence rate and corneal endothelial morphological changes of patients treated with combined treatment of glucocorticoid and antiviral drugs after 3mo were compared and analyzed statistically. · RESULTS: Corneal endotheliitis patients had many predisposing factors and symptoms like red eye, eye pain, photophobia, tears and decreased visual acuity, blurred vision and others, clinical manifestations include decreased visual acuity,conjunctival congestion or mixed ciliary congestion, corneal edema, corneal epithelium might have small blisters, Descemet membrane folds, gray white or white like KP, intraocular pressure increased, posterior synechia, cases of several recurrent had corneal bullous occurred. After 1mo of treatment,the effective rate was 100%,the cure rate was 88%,and there was no recurrence; after 2mo of treatment the effective rate and the cure rate was 100%, a total of 1 cases (2%) recurrence;treatment for 3mo, a total of 2 cases (4%) recurrence. After 3mo of treatment cell count (t=2.952, P=0.004) and corneal thickness by OCT (t=2.584, P=0.011) of the treatment group were lower than those of the control group, the difference was statistically significant; cell pleomorphic mutation rate (45. 85% ± 6.29%) of the treatment group was higher than that of the control group (40. 62% ± 5. 16%), the difference was statistically significant (t=4.458, P<0.001). The visual acuity of treatment group was poorer before treatment than that of the control group, the difference was statistically significant (Z = - 5. 766, P < 0. 001); after treatment, the visual acuity increased to 0. 20 (0. 10-0.40),there were significant differences before and after the treatment (Z=-6.089,P<0.001). ·CONCLUSION: The clinical manifestations and etiology of viral corneal endotheliitis is complex. Application of antiviral drugs and glucocorticoid treatment, can obtain good effect, but after the treatment, corneal thickness and corneal endothelial cell count decreased, higher requirements for the safety of the treatment is needed.
ABSTRACT
· AIM: To analyze the pathogeny of corneal endotheliitis and to investigate the causes of its misdiagnosis and the key to treatment.endotheliitis presented with predisposing factors, clinical manifestations and treatment were analyzed retrospectively.junctiviis, and the other 7 were misdiagnosed as acute close-angle glaucoma, glaucomatocyclitic crisis, inflammatory reaction after cataract extracapsular extraction and IOL implantation, disciform stromal keratitis and iridocyclitis, respectively. All the 7 cases were cured through treatment, and recurrence appeared in 1 case.unclear yet. Properly grasping its features and key points for differential diagnosis and seriously and detailed examining patients will benefit to timely diagnosis. After clinical treatment, maintaining treatment for more than 4wk will lower the recurrence of corneal endotheliitis.
ABSTRACT
It is not uncommon for corneal endotheliitis in clinic.Misdiagnosis of the disease was often happened because of the insufficient knowledge on it and lacking of specific examine methods.It is the most important method for avoiding misdiagnosis of corneal endotheliitis to recognize its clinic features and detailed inquiring case history.