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Topical ganciclovir treatment post-Descemet’s stripping automated endothelial keratoplasty for patients with bullous keratopathy induced by cytomegalovirus
  1. Koji Kitazawa1,2,
  2. Passara Jongkhajornpong3,
  3. Tsutomu Inatomi4,
  4. Noriko Koizumi5,
  5. Kanae Kayukawa2,
  6. Koichi Wakimasu2,
  7. Chie Sotozono4,
  8. Shigeru Kinoshita1,2
  1. 1 Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  2. 2 Ophthalmology, Baptist Eye Institute, Kyoto, Japan
  3. 3 Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand
  4. 4 Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  5. 5 Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
  1. Correspondence to Dr Tsutomu Inatomi, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; tinatomi{at}


Background/aims To investigate the efficacy of topical ganciclovir (GCV) for preventing disease recurrence and improving the surgical outcome post-Descemet’s stripping automated endothelial keratoplasty (DSAEK) in patients with cytomegalovirus (CMV) endotheliitis.

Methods This prospective, non-comparative case series study involved six eyes of six patients with endothelial decompensation due to CMV endotheliitis who underwent DSAEK, followed by a continuous, four to six times daily, topical administration of 0.5% GCV. Patient demographics, clinical history, and preoperative and postoperative examination (including any recurrence of CMV endotheliitis post-DSAEK), best corrected visual acuity (BCVA), intraocular pressure (IOP), graft survival rate and endothelial cell density (ECD) were examined.

Results No recurrence of CMV endotheliitis was detected post-DSAEK. The mean follow-up period was 40 months (range, 12–60 months). The mean preoperative BCVA was 1.52±0.68 LogMAR (range, 0.52–2.40 LogMAR), yet it had significantly improved to 0.15±0.16 LogMAR (range: −0.08 to 0.30 LogMAR) by 1 year postoperative (P<0.01). In all patients, IOP was well controlled (10–20 mm Hg) postsurgery. The mean preoperative donor ECD was 2692±177 cells/mm2, and the mean postoperative ECD was 1974, 1771 and 1174 cells/mm2 for the ECD loss of 26%, 33% and 54% at 6, 12 and 36 months, respectively. No adverse effects were observed associated with the long-term topical administration of GCV.

Conclusion The continuous topical application of 0.5% GCV was found to be effective for preventing the recurrence of CMV endotheliitis, and it provided the optimal mid-term clinical outcomes post-DSAEK in patients with CMV endotheliitis.

Trial registration number UMIN000026746

  • cytomegalovirus endotheliitis
  • Descemet’s stripping automated endothelial keratoplasty
  • ganciclovir

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  • Contributors Conception and design of the study (TI, NK, CS, SK); collection of data (KK, PJ); management of data (KK, TI); analysis of data (KK, PJ, TI); interpretation of data (KK, PJ, TI); writing of the article (KK, PJ, TI); approval of the manuscript (KK, PJ, TI, NK, KK, KW, CS, SK); obtaining of funding (SK); searching the literature (KK, PJ).

  • Funding This study was supported in part by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science, Culture, and Sports of Japan.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics Review Board (ERB) of Kyoto Ethics Review Committee (ERB approval number 1604).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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