Chew Milton C, Tan Donald T, Chee Soon-Phaik, Li Lim
Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, Singapore, 168751, Singapore.
Singapore Eye Research Institute, Singapore, Singapore.
J Ophthalmic Inflamm Infect. 2019 Aug 2;9(1):15. doi: 10.1186/s12348-019-0180-0.
There is limited information regarding Descemet stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to cytomegalovirus (CMV) endotheliitis. Treatment is difficult with high recurrence rates. We describe a case when systemic valganciclovir therapy is directed by aqueous CMV-DNA levels, leading to good graft survival.
A 59-year-old male with bilateral CMV endotheliitis despite antiviral therapy developed endothelial failure and underwent DSAEK. Prior to surgery, aqueous polymerase chain reaction (PCR) for CMV was repeatedly performed, where CMV-positive episodes were treated with systemic valganciclovir. Monthly aqueous analysis was performed until CMV-DNA was undetectable before DSAEK was performed. Post-operative prophylactic systemic valganciclovir treatment was instituted and switched to topical valganciclovir treatment when aqueous samples were negative for CMV.
Targeted aqueous sampling for CMV-DNA perioperatively guides antiviral therapy and ensures adequacy of treatment, minimising the duration of systemic valganciclovir therapy to reduce adverse effects of long-term treatment.
关于因巨细胞病毒（CMV）内皮炎继发内皮功能衰竭而行Descemet膜剥脱自动内皮角膜移植术（DSAEK）的信息有限。治疗困难且复发率高。我们描述了一例通过房水CMV-DNA水平指导全身使用缬更昔洛韦治疗，从而实现移植物良好存活的病例。
一名59岁男性，尽管接受了抗病毒治疗，但仍发生双侧CMV内皮炎，进而出现内皮功能衰竭并接受了DSAEK手术。术前反复进行房水巨细胞病毒聚合酶链反应（PCR）检测，CMV呈阳性发作时给予全身使用缬更昔洛韦治疗。每月进行房水分析，直至在进行DSAEK手术前检测不到CMV-DNA。术后开始进行预防性全身使用缬更昔洛韦治疗，当房水样本CMV检测为阴性时改为局部使用缬更昔洛韦治疗。
围手术期针对CMV-DNA进行靶向房水采样可指导抗病毒治疗并确保治疗充分性，将全身使用缬更昔洛韦治疗的持续时间降至最低，以减少长期治疗的不良反应。
