Wong Angela H Y, Kua Wee Nie, Young Alvin L, Wan Kelvin H
Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China.
Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
Eye Vis (Lond). 2021 Jan 14;8(1):3. doi: 10.1186/s40662-020-00226-y.
Cytomegalovirus (CMV) can manifest as corneal endotheliitis in immunocompetent individuals. Early diagnosis is prudent to prevent endothelial cell loss, which could ultimately lead to corneal decompensation. CMV DNA was first detected in an eye with corneal endotheliitis in 2006; since then, clinical evidence from numerous case reports and case series have accumulated.
In this narrative review, we identified several drugs, including ganciclovir, valganciclovir, and their combination in oral, intravenous, intravitreal, and topical forms in different concentrations, together with the judicious use of topical steroids, have reported variable success. There has yet to be any prospective comparative study evaluating the efficacy and safety of these assorted forms of treatment; clinical evidence is based on case reports and case series. CMV endotheliitis presenting with corneal edema can masquerade as other corneal diseases and thus poses a great challenge especially in post-keratoplasty eyes. Heightened awareness is needed before and after keratoplasty to start prompt prophylaxis and treatment.
There is no consensus on the management of CMV endotheliitis. Further studies are much needed to elucidate the optimal treatment modality, regime, and duration in the treatment and prophylaxis of CMV endotheliitis.
巨细胞病毒（CMV）可在免疫功能正常的个体中表现为角膜内皮炎。早期诊断对于预防内皮细胞丢失至关重要，因为这最终可能导致角膜失代偿。2006年首次在一例角膜内皮炎患者的眼中检测到CMV DNA；从那时起，众多病例报告和病例系列的临床证据不断积累。
在这篇叙述性综述中，我们发现几种药物，包括更昔洛韦、缬更昔洛韦，以及它们不同浓度的口服、静脉注射、玻璃体内注射和局部用药形式的联合使用，同时合理使用局部类固醇，已报道有不同程度的成功。尚未有任何前瞻性比较研究评估这些不同治疗形式的疗效和安全性；临床证据基于病例报告和病例系列。表现为角膜水肿的CMV内皮炎可能会伪装成其他角膜疾病，因此尤其在角膜移植术后的眼中构成巨大挑战。角膜移植术前和术后都需要提高认识，以便及时开始预防和治疗。
对于CMV内皮炎的治疗尚无共识。迫切需要进一步研究以阐明CMV内皮炎治疗和预防的最佳治疗方式、方案和持续时间。
