Relationships between the clinical characteristics and copy numbers of DNA of cytomegalovirus determined by real-time PCR

Ayano Yoshimura,Rho Fujiwara,Nobuo Jho,Kaoru Araki-Sasaki,Noriko Toyokawa,Fumi Gomi

doi:10.1007/s10792-020-01412-6

Abstract

PurposeTo determine whether there is a correlation between the clinicals characteristics including various types of keratic precipitates and the copy numbers of the DNA of cytomegalovirus (CMV) in eyes with CMV corneal endotheliitis.MethodsWe reviewed the medical charts of four cases of corneal endotheliitis that were CMV-positive. We have classified types of clinical phenomenon into four types: coin-shaped KPs, sectoral corneal edema with or without Khodadoust line-like KPs, mutton-fat KPs, and fine KPs and have graded their severity. We also determined the copy numbers of the DNA of CMV in the aqueous humor by real-time polymerase chain reaction before and during the treatment. We evaluated the correlation between the patterns of clinical characteristics and copy number of the DNA of CMV.ResultsThere were clinical improvements in all eyes following topical ganciclovir in conjunction with low dose of topical steroid treatment, with or without oral valganciclovir. The clinical characteristics and the copy numbers of the DNA of CMV varied during the treatment period. The presence of coin-shaped KPs was correlated with high copy numbers (105–103 copies/ml) of the DNA of CMV. The copy numbers of the DNA of CMV with sectoral corneal edema with or without Khodadoust line-like KPs ranged from 104 to 102 copies/ml, and it was occasionally accompanied by high intraocular pressure. Mutton-fat KPs were observed inferiorly, sometimes together with coin-shaped KPs and sectoral corneal edema, or solely. The copy numbers in eyes with mutton-fat KPs varied and occasionally less than the cutoff level. Fine-pigmented KPs were observed after the resolution of the endotheliitis, and no DNA of CMV was detected in the aqueous humor.ConclusionsCareful observations of the clinical characteristics such as the KPs and corneal edema might be helpful in estimating the amount of the DNA of CMV in eyes with corneal endotheliitis.

Highlights

Corneal endotheliitis, first characterized by Khodadoust and Attarzadeh [1], is characterized by the presence of linear keratic precipitates (KPs) similar to that found in eyes with corneal endothelial rejection
The copy numbers of the DNA of CMV with sectoral corneal edema with or without Khodadoust line-like KPs ranged from 104 to 102 copies/ml, and it was occasionally accompanied by high intraocular pressure
Fine-pigmented KPs were observed after the resolution of the endotheliitis, and no DNA of CMV was detected in the aqueous humor

Summary

Introduction

First characterized by Khodadoust and Attarzadeh [1], is characterized by the presence of linear keratic precipitates (KPs) similar to that found in eyes with corneal endothelial rejection. Ohashi et al [2] reported on a unique corneal endothelialitis that consisted of severe stromal edema associated with keratic precipitates. This endotheliitis was of viral origin, especially the herpes simplex virus (HSV). Amano [3] reported that the herpes simplex virus can cause trabeculitis and increased intraocular pressure (IOP) in patients with corneal endotheliitis. The characteristics of this clinical entity, such as coinshaped regions and Khodadoust line-like KPs with corneal edema, were reported in eyes with corneal endotheliitis by a multicenter clinical study [6]

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