valganciclovir and Keratitis--Herpetic

Corneal endotheliitis was first reported as an autoimmune disease by Khodadoust in 1982. Thereafter, herpes simplex virus (HSV) was detected as a causative agent, and corneal endotheliitis was classified as an infectious disease. However, most primary corneal endotheliitis had been idiopathic. In 2006, cytomegalovirus (CMV) DNA was detected in a case of corneal endotheliitis, and other reports on CMV endotheliitis from Asian countries established it as a new clinical entity. Limited studies have reported clinical findings, and the pathogenesis of HSV and CMV corneal endotheliitis is unknown. Therefore, this review describes what is currently known about the pathogenesis of HSV and CMV endotheliitis by way of previously reported case studies and basic research. In addition, we review work by our own group regarding the role of Toll-like receptor 9 and the results of transcriptome analysis after HSV infection in an in vitro model using immortalized human corneal endothelial cells. It is critical to diagnose corneal endotheliitis early to provide effective treatment with ganciclovir or valganciclovir and prevent the loss of corneal endothelial cells. Therefore, we hope that these in vitro results may provide further information to help elucidate the in vivo pathogenesis of HSV and CMV endotheliitis.

Topics: Antiviral Agents; Cytomegalovirus Infections; Endothelium, Corneal; Eye Infections, Viral; Ganciclovir; Humans; Keratitis, Herpetic; Toll-Like Receptor 9; Valganciclovir

To describe 4 cases of presumably immunocompetent patients with herpes simplex virus (HSV) keratitis unresponsive (n = 3) or allergic (n = 1) to conventional antiviral therapy that improved with oral valganciclovir treatment.. Retrospective case series of 4 patients with HSV keratitis treated with oral valganciclovir between March 2016 and June 2018.. We reviewed the records of 4 patients with recurrent epithelial HSV keratitis. Three patients were on antiviral prophylaxis because of a history of HSV keratitis. All patients were on oral acyclovir, valacyclovir, and/or famciclovir treatment with/without topical antiviral therapy for 4 to 6 months for prophylaxis and/or recurrent dendriform epithelial keratitis. While 3 patients had recurrent episodes during their active prophylaxis with oral antiviral therapies, one patient had a recurrence after she discontinued her oral prophylactic antiviral therapy due to recurrent self-reported allergic reactions. The patients presented with recurrent dendriform epithelial keratitis despite conventional antiviral therapy. We initiated oral valganciclovir 900 mg twice a day for 10 days as a treatment dose, followed by 900 mg daily for prophylaxis. The corneal epithelium subsequently healed within the first 2 weeks in all patients. The mean follow-up time for patients on valganciclovir prophylaxis was 8 months (range: 6-12 months), and none of the patients presented with any further recurrences.. In case of treatment-related side effects or failure with conventional antiviral therapies, oral valganciclovir may present an alternative for the treatment and prophylaxis of HSV keratitis.

Topics: Administration, Oral; Aged; Aged, 80 and over; Antiviral Agents; Female; Humans; Keratitis, Herpetic; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Valganciclovir

To describe an atypical case of cytomegalovirus (CMV) endotheliitis in a 74-year-old man who presented with chronic corneal edema without keratic precipitates (KPs) and intraocular pressure (IOP) elevation.. Case report.. A complete ophthalmologic examination was performed. Polymerase chain reaction was used to test for herpes simplex virus, varicella zoster virus, and CMV DNA in aqueous humor samples to rule out viral endotheliitis.. Severe bullous keratopathy was found in the temporal part of the cornea without KPs or elevated IOP. CMV DNA was detected. Corneal edema subsided with oral valganciclovior.. CMV endotheliitis may present as corneal edema that lacks typical features, such as KPs or elevated IOP.

Topics: Acyclovir; Aged; Antiviral Agents; Corneal Edema; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Endothelium, Corneal; Ganciclovir; Humans; Intraocular Pressure; Keratitis, Herpetic; Male; Prednisolone; Valacyclovir; Valganciclovir; Valine; Visual Acuity