Presentation
Of the 122 DMEK surgeries in the series, only 4 patients were diagnosed with CMV corneal endotheliitis; presentation occurred 5 to 15 weeks after DMEK. Outcomes All 4 cases presented with keratic precipitates and anterior uveitis. [aao.org]
Key Method The patient had no documented positive history of ocular surgery and no abnormal findings were present in the fellow eye. [semanticscholar.org]
They are surface proteins that interact with integrins and are present on endothelial cells, leukocytes and other cells. [flexikon.doccheck.com]
Discussion Cornea graft rejection and viral infection can present with very similar clinical presentation, particularly in cases with multiple history of penetrating keratoplasty. [egms.de]
[…] is unusual distribution of keratic precipitates (KP) behind zones of edema.2 Depending on the presentation, however, KP may or may not be visible. [reviewofcontactlenses.com]
Cardiovascular
- Hypertension
Patients were commonly diagnosed with anterior uveitis and ocular hypertension prior to confirmation of CMV endotheliitis. [bjo.bmj.com]
Case report A 59-year-old gentleman presented in May 2008 for persistent corneal edema, with a history of bilateral recurrent anterior hypertensive uveitis. [joii-journal.springeropen.com]
The framework of endotheliitis provides an explanation for the unique predilection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in those individuals with hypertension, diabetes, or established cardiovascular disease, a group known to [virustietoutta.blogspot.com]
A case of hypertensive keratouveitis with endotheliitis associated with cytomegalovirus. Ocul Immunol Inflamm 2007; 15: 399–401. 9 Shiraishi A, Hara Y, Takahashi M, Oka N, Yamaguchi M, Suzuki T et al. [nature.com]
This is typical of CMV acute hypertensive anterior uveitis. This slit lamp photograph shows a swollen cornea with Descemet's folds and small keratic precipitates in an eye with CMV endotheliitis. [eyeworld.org]
- Hypotension
The intraocular pressure gradually decreased to less than 15 mm Hg without hypotensive agents. The best-corrected visual acuity recovered to 20/20 along with improved slitlamp findings. [jamanetwork.com]
Oral Dosing Acyclovir Valacyclovir Famciclovir Prophylactic 400mg BID 500mg QD 250mg BID Therapeutic 400mg 3-5x/day 500mg BID 250mg BID Enhanced therapeutic 800mg 5x/day 1g TID 500mg BID Cycloplegics aid to prevent iris synechiae.1,4 Topical hypotensives [reviewofoptometry.com]
Eyes
- Anterior Uveitis
Tan, MD, discussing their experience in the diagnosis, treatment, and sequelae of CMV anterior uveitis and endotheliitis. Clara C. [eyeworld.org]
Case Report: A;45 year-old female with corneal endothelial decompensation and a mature cataract, and history of anterior uveitis underwent simultaneous phacoemulsification, IOL implantation and DMEK. [miami.pure.elsevier.com]
Uveitis. 61 Chan NS...Bodaghi B 29172842 2018 44 Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers. 61 Relvas LJM...Caspers L 29377783 2018 45 Cytomegalovirus Anterior Uveitis Following Topical Cyclosporine A. 61 Siak J.. [malacards.org]
In this study, we recruit 7 immunocompetent patients with unexplained graft failures, which mimicked herpetic anterior uveitis and graft rejection initially, were diagnosed as CMV endotheliitis after aqueous tapping for CMV polymerase chain reaction [clinicaltrials.gov]
Patients were commonly diagnosed with anterior uveitis and ocular hypertension prior to confirmation of CMV endotheliitis. [bjo.bmj.com]
Neurologic
- Stroke
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020; 382 (20): e60. doi: 10.1056/NEJMc2009787. [ Links ] 28. Azouz E, Yang S, Monnier-Cholley L, Arrivé L. [scielo.cl]
Treatment
The treatment plan differs according to the etiology. [journals.lww.com]
Post-operative prophylactic systemic valganciclovir treatment was instituted and switched to topical valganciclovir treatment when aqueous samples were negative for CMV. [joii-journal.springeropen.com]
Medical treatment for CMV endotheliitis In Japan, ganciclovir is available for the treatment of intravenous infusion, and valganciclovir hydrochloride tablets for CMV infection. [bjo.bmj.com]
It responds well to antiviral and steroids treatment, although, on those patients who don't improve, is necesary to make additional tests. [scielo.br]
The treatment of CMV-related corneal endotheliitis should cover both infectious and inflammatory components. Systemic antiviral treatment with topical corticosteroids should be started. [egms.de]
Prognosis
This exudative-AMD has a peculiar clinical history and prognosis. RAP accounts from 8% to 22% of newly diagnosed cases among patients previously diagnosed as exudative AMD, and up to 25% of the occult or minimally classic CNV. [read.qxmd.com]
Presentation of Acanthamoeba Keratitis. 61 Hsu CW...Hsiao CH 31219868 2019 12 A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment. 61 Moshirfar M...Hoopes PC 30859513 2019 13 Therapeutic Challenges and Prognosis [malacards.org]
"CMV endotheliitis appears to carry a worse prognosis than other forms of endotheliitis, including HSV, with a higher rate of recurrence and a higher risk of graft failure," he said. PCR is often the simplest and surest way to tell them apart, Dr. [eyeworld.org]
[…] no previous report of corneal endotheliitis caused by coxsackievirus A24 (CA24), whereas CA24 is known to be a common causative agent of acute hemorrhagic conjunctivitis (AHC).7 Thus, we had not been made aware of the clinical course, treatment, or prognosis [docksci.com]
Such cases are diagnosed as ‘idiopathic corneal endotheliitis’,3 and their prognosis is poor due to the progressive destruction of corneal endothelium that is resistant to antiviral medication. [bjo.bmj.com]
Etiology
The disease etiology c...read more Mentioned in this Paper Keratitis Virus Diseases Simplexvirus Topical form corticosteroids Neonatal Herpes Anterior Chamber of Eye Structure Fuchs Endothelial Dystrophy Corneal Edema Herpes Zoster Ophthalmicus Etiology [meta.org]
The disease etiology consists of accumulating evidence of various viral infections including herpes simplex virus, varicella zoster virus, and cytomegalovirus. [ncbi.nlm.nih.gov]
The treatment plan differs according to the etiology. [journals.lww.com]
[…] of infectious interstitial keratitis, such as other viruses (Varicella zoster virus, Epstein-Barr virus), bacteria (syphilis, lyme), fungus, and Acanthamoeba, as well as immune-mediated etiologies, including sarcoidosis and Cogan syndrome. [eyewiki.aao.org]
Epidemiology
The epidemiology of HSV endotheliitis is less clear at least in part because many publications include disciform HSV endotheliitis as a form of HSK. [eyewiki.aao.org]
Pathophysiology
Endotheliitis is an under-recognized pathophysiologic process that causes various types of dysfunction in end organs, including heart, lung, kidney, and brain. [pubmed.ncbi.nlm.nih.gov]
Cugno Medicine, Biology Clinical Reviews in Allergy & Immunology 2017 An increasing body of evidence supports the role of pro-inflammatory cytokines like interleukin (IL)-1-beta, IL-17 and tumour necrosis factor (TNF)-alpha in the pathophysiology of neutrophilic [semanticscholar.org]
Intraocular pressure may be elevated secondary to trabeculitis. [14] Pathophysiology The pathophysiology of HSK is complex and remains incompletely understood. [eyewiki.aao.org]
Prevention
Therefore unnecessary treatment resulting from misdiagnosis in these patients can be prevented. Early recognition and treatment of this condition is important to prevent permanent endothelial cell loss and corneal decompensation. [egms.de]
Topical ganciclovir was used to control and prevent the reactivation of CMV without systemic application and their clinical courses were presented after this treatment modality. [clinicaltrials.gov]
A potentially useful mechanism of therapy, therefore, involves inhibiting viral reactivation to prevent recurrent corneal inflammation. [eyewiki.aao.org]