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Speaker: High index of suspicion necessary to diagnose cytomegalovirus endotheliitis

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LAS VEGAS — A high index of suspicion is necessary in order to diagnose cytomegalovirus endotheliitis, according to a speaker here.

“Failure to do so can result in an irreversible graft failure,” Anshu Arundhati, MD, said at the American Academy of Ophthalmology annual meeting.

Anshu Arundhati

The prospective case series included 58 eyes with suspected cytomegalovirus (CMV) endotheliitis. Arundhati and colleagues performed aqueous CMV polymerase chain reaction to confirm a diagnosis of CMV endotheliitis.

Twenty-eight eyes developed CMV endotheliitis, 16 eyes had pre-existing glaucoma, and 12 had glaucoma surgery, Arundhati said.

“There was a very high incidence of glaucoma in these patients. ... Overall, 67.8% of patients require some form of glaucoma surgery to manage their glaucoma,” she said.

According to the study, corneal edema, fine pigmented keratic precipitates and minimal anterior chamber activity were highly suspicious indicators for CMV endotheliitis.

For treatment of the disease, 85.7% of patients were administered a combination of topical ganciclovir and systemic valganciclovir. The remaining patients were treated with only ganciclovir due to the patients’ inability to afford valganciclovir, Arundhati said.

“Of the 19 eyes that had CMV post-graft, none of them had CMV recurrence following treatment of systemic and/or topical antiviral therapy, but five grafts failed. ... The reasons were because they were unable to afford treatment,” she said.

The rate of failed grafts was significantly lower when the number of patients who could not afford treatment were excluded, Arundhati said.

“Currently, available treatment is effective but expensive and also has the risk of adverse reactions. Better and affordable therapeutic options are needed to further improve outcomes,” she said. – by Nhu Te

Reference:

Arundhati A. Outcomes of cytomegalovirus endotheliitis in corneal grafts. Presented at: American Academy of Ophthalmology meeting. Nov. 16, 2015; Las Vegas.

Disclosure: Arundhati reports no relevant financial disclosures.