Outcomes of Corneal Transplantation for Irreversible Corneal Decompensation Secondary to Corneal Endotheliitis in Asian Eyes

Abstract

To describe outcomes of corneal transplantation for irreversible corneal decompensation from corneal endotheliitis in Asian eyes. Retrospective, observational case series. We reviewed consecutive patients with corneal endotheliitis (32 eyes of 31 subjects) who underwent keratoplasty (January 1, 2008-December 1, 2009). All eyes had preoperative aqueous polymerase chain reaction(PCR) analysis for viruses, including cytomegalovirus (CMV). CMV-positive patients were treated preoperatively with topical corticosteroids and anti-CMV treatment (oral valganciclovir 900mg twice daily, topical ganciclovir 0.15% 5 applications per day, for 6weeks) with complete resolution of ocular inflammation, and quiescence for at least 6months before corneal transplantation. Our main outcome measure was recurrence of endotheliitis within 1 year after corneal transplantation. Five eyes were CMV positive; the remaining 27 eyes were negative for all viruses on PCR analysis. CMV-positive patients had a higher rate of recurrence of endotheliitis within 1 year after corneal transplantation, compared with CMV-negative eyes (60% vs 7.4%, P= .01). The CMV-positive eyes had recurrent endotheliitis at a median of 10months (range 3-11months) after corneal transplantation. After successful anti-CMV treatment, all 5 CMV-positive eyes then continued to have clear grafts for a median duration of 21months (range 13-44months). Our study suggests that Asian patients with corneal endotheliitis may benefit from preoperative aqueous PCR analysis before corneal transplantation. Such patients were more likely to have a recurrence of endothelial inflammation if they were CMV positive preoperatively, despite successful anti-CMV treatment before surgery.