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Noriko Koizumi - One of the best experts on this subject based on the ideXlab platform.
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Topical ganciclovir treatment post-Descemet’s stripping automated endothelial keratoplasty for patients with bullous keratopathy induced by cytomegalovirus
British Journal of Ophthalmology, 2018Co-Authors: Koji Kitazawa, Noriko Koizumi, Tsutomu Inatomi, Passara Jongkhajornpong, Kanae Kayukawa, Koichi Wakimasu, Chie Sotozono, Shigeru KinoshitaAbstract: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 2 , and the mean postoperative ECD was 1974, 1771 and 1174 cells/mm 2 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
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the effect of topical application of 0 15 ganciclovir gel on cytomegalovirus corneal Endotheliitis
British Journal of Ophthalmology, 2017Co-Authors: Tomoyuki Inoue, Noriko Koizumi, Tsutomu Inatomi, Dai Miyazaki, Chie Sotozono, Fumie Ohtani, Michiko Kandoriinoue, Hiroko Nakagawa, Tomoko HorikiriAbstract:Background/aims The aim of this study was to evaluate the therapeutic efficacy and drug transfer of topical application of 0.15% ganciclovir (GCV) gel on cytomegalovirus (CMV) corneal Endotheliitis. Methods This study is a multicentre, prospective, interventional case series. Seven eyes of seven immunocompetent patients diagnosed with CMV corneal Endotheliitis, based on clinical manifestations and qualitative PCR, were enrolled in this study. The patients were treated with topical applications of 0.15% GCV gel six times daily for 12 weeks without concomitant systemic GCV. Clinical evaluations and quantitative PCR of CMV were performed, and GCV concentrations in aqueous humour were measured by liquid chromatography/tandem mass spectrometry. Results Clinical improvement of coin-shaped lesions, other types of keratic precipitates, corneal oedema, and anterior chamber inflammation was confirmed at the 4-week visit in all seven eyes. The GCV treatment significantly decreased the CMV copy numbers (p Conclusions Clinical improvement and reduced CMV copy numbers in the aqueous humour were confirmed in the CMV corneal Endotheliitis cases. Although the case numbers are limited and long-term follow-up is necessary, the topical application of 0.15% GCV gel appears to be a useful treatment option for CMV Endotheliitis. Trial registration number UMIN000012435.
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The effect of topical application of 0.15% ganciclovir gel on cytomegalovirus corneal Endotheliitis
British Journal of Ophthalmology, 2016Co-Authors: Noriko Koizumi, Tomoyuki Inoue, Tsutomu Inatomi, Dai Miyazaki, Chie Sotozono, Fumie Ohtani, Hiroko Nakagawa, Tomoko Horikiri, Michiko Kandori-inoue, Mayumi UetaAbstract:Background/aims The aim of this study was to evaluate the therapeutic efficacy and drug transfer of topical application of 0.15% ganciclovir (GCV) gel on cytomegalovirus (CMV) corneal Endotheliitis. Methods This study is a multicentre, prospective, interventional case series. Seven eyes of seven immunocompetent patients diagnosed with CMV corneal Endotheliitis, based on clinical manifestations and qualitative PCR, were enrolled in this study. The patients were treated with topical applications of 0.15% GCV gel six times daily for 12 weeks without concomitant systemic GCV. Clinical evaluations and quantitative PCR of CMV were performed, and GCV concentrations in aqueous humour were measured by liquid chromatography/tandem mass spectrometry. Results Clinical improvement of coin-shaped lesions, other types of keratic precipitates, corneal oedema, and anterior chamber inflammation was confirmed at the 4-week visit in all seven eyes. The GCV treatment significantly decreased the CMV copy numbers (p Conclusions Clinical improvement and reduced CMV copy numbers in the aqueous humour were confirmed in the CMV corneal Endotheliitis cases. Although the case numbers are limited and long-term follow-up is necessary, the topical application of 0.15% GCV gel appears to be a useful treatment option for CMV Endotheliitis. Trial registration number UMIN000012435.
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clinical features and management of cytomegalovirus corneal Endotheliitis analysis of 106 cases from the japan corneal Endotheliitis study
British Journal of Ophthalmology, 2015Co-Authors: Takashi Suzuki, Yuichi Ohashi, Yoshitsugu Inoue, Noriko Koizumi, Tsutomu Inatomi, Atsushi Shiraishi, Michiko Kandori, Dai Miyazaki, Takeshi SomaAbstract:Aims The purpose of this study is to elucidate the clinical manifestations and the current treatment status of cytomegalovirus (CMV) Endotheliitis via a large case series obtained from a national survey conducted in Japan. Methods The Japan Corneal Endotheliitis Study Group proposed diagnostic criteria for CMV Endotheliitis based on a viral examination by PCR of aqueous humour, in combination with clinical manifestations. A national survey was then retrospectively conducted among 1160 members of the Japan Cornea Society. The study reviewed the patient profiles, clinical manifestations, and treatment modalities of individuals who met the diagnostic criteria for CMV Endotheliitis. Results The study included 109 eyes of 106 patients. Mean patient age was 66.9±10.9 years (85 males (80.2%), 21 females (19.8%)). Patients were commonly diagnosed with anterior uveitis and ocular hypertension prior to confirmation of CMV Endotheliitis. Coin-shaped lesions were observed in 70.6%, and linear keratic precipitates in 8.3% of the patients, respectively. 95% of cases were treated with anti-CMV drugs. Conclusions CMV Endotheliitis is most common in middle-aged and elderly men. CMV Endotheliitis should be suspected when patients present with corneal Endotheliitis involving coin-shaped lesions accompanied by anterior uveitis and ocular hypertension.
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Detection of cytomegalovirus DNA from cytomegalovirus corneal Endotheliitis after penetrating keratoplasty.
Cornea, 2010Co-Authors: Hiroko Sonoyama, Noriko Koizumi, Shigeru Kinoshita, Shiro Amano, Kaoru Araki-sasaki, Yasuhiro Osakabe, Masaki Nakamura, Hidenao IdetaAbstract:To report the detection of cytomegalovirus (CMV) DNA in the cornea of a CMV Endotheliitis patient after penetrating keratoplasty (PKP). A 71-year-old man without immunodeficiency developed corneal Endotheliitis in the right eye. The patient had previously received PKP several times. Polymerase chain reaction (PCR) detected CMV-DNA in the aqueous humor in his affected eye, and we started administration of ganciclovir. There was resolution of the inflammation; however, bullous keratopathy was subsequently noted in the cornea. Additional PKP was performed with perioperative intravenous administration of ganciclovir. The failed graft obtained during the additional PKP was subjected to PCR analysis and histopathological examination. PCR analysis showed CMV-DNA in the failed graft. Little inflammatory change was noted in either the epithelial or stromal layers of the failed graft. With continued ganciclovir treatment, the graft remained clear and no recurrence or rejection occurred until 12 months after the last PKP. Our PCR analysis showed the presence of CMV-DNA within the cornea of the patient with corneal Endotheliitis.
Kazuhisa Sugiyama - One of the best experts on this subject based on the ideXlab platform.
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in vivo imaging of coin shaped lesions in cytomegalovirus corneal Endotheliitis by anterior segment optical coherence tomography
Cornea, 2014Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Kazuhisa SugiyamaAbstract:Abstract The aim of this study was to investigate in vivo corneal changes of coin-shaped lesions in cytomegalovirus corneal Endotheliitis using anterior segment optical coherence tomography (AS-OCT). Two eyes of 2 patients (69- and 71-year-old men), with polymerase chain reaction-proven CMV corneal Endotheliitis presenting coin-shaped lesions, were included in this study. AS-OCT examination was performed on the initial visit and at follow-up visits by paying special attention to the coin-shaped lesions. Selected AS-OCT images of the cornea were evaluated qualitatively for changes in the shape and degree of light reflection. In both cases, coin-shaped lesions were observed at the corneal endothelial surface as clusters of fine precipitates using slit-lamp biomicroscopy. Using AS-OCT, high-resolution images of the putative coin-shaped lesions were successfully obtained in both patients as an irregularly thickened highly reflective endothelial cell layer. After anti-CMV treatment, the coin-shaped lesions were resolved as assessed by slit-lamp biomicroscopy and AS-OCT in both patients. High-resolution AS-OCT provides novel and detailed visual information of coin-shaped lesions in patients with CMV corneal Endotheliitis. Visualization of coin-shaped lesions by AS-OCT may be a useful adjunct to the diagnosis and follow-up of CMV corneal Endotheliitis.
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Identification of cytomegalovirus and human herpesvirus-6 DNA in a patient with corneal Endotheliitis
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Kazuhisa SugiyamaAbstract:Purpose To report the case of a patient with unilateral corneal Endotheliitis in which both cytomegalovirus (CMV) and human herpesvirus-6 (HHV6) DNA was identified in the aqueous humor. Case A 67-year-old man with corneal Endotheliitis OD was referred to us for decreased visual acuity. Local corneal stromal edema, pigmented keratic precipitates, a coin-shaped lesion and minimal anterior chamber reaction were observed by slit-lamp biomicroscopy. Cells with owl’s eye appearance in the endothelial cell layer were observed by in vivo laser confocal microscopy. The patient had rheumatoid arthritis, which was treated by oral prednisolone and intravenous abatacept. Polymerase chain reaction analysis of aqueous humor samples detected both CMV and HHV6 DNA, but not other HHVs. Treatment with topical ganciclovir and systemic valganciclovir resulted in a clear cornea. Conclusions A patient with corneal Endotheliitis had both CMV and HHV6 DNA identified in the aqueous humor. Although both viruses were identified in this case, clinical manifestations resembled CMV corneal Endotheliitis, and it was unclear whether HHV6 could affect the clinical course. Systemic abatacept and corticosteroid therapy might play a positive role in cases with both CMV and HHV6 DNA in this corneal Endotheliitis.
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identification of cytomegalovirus and human herpesvirus 6 dna in a patient with corneal Endotheliitis
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Kazuhisa SugiyamaAbstract:Purpose To report the case of a patient with unilateral corneal Endotheliitis in which both cytomegalovirus (CMV) and human herpesvirus-6 (HHV6) DNA was identified in the aqueous humor.
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Mapping owl’s eye cells of patients with cytomegalovirus corneal Endotheliitis using in vivo laser confocal microscopy
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Kazuhisa SugiyamaAbstract:Purpose To produce a two-dimensional reconstruction map of owl’s eye cells using in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal Endotheliitis, and to demonstrate any association between owl’s eye cells and coin-shaped lesions observed with slit-lamp biomicroscopy. Method Two patients (75- and 77-year-old men) with polymerase chain reaction-proven CMV corneal Endotheliitis were evaluated in this study. Slit-lamp biomicroscopy and in vivo laser confocal microscopy were performed. Images of owl’s eye cells in the endothelial cell layer were arranged and mapped into subconfluent montages. Montage images of owl’s eye cells were then superimposed on a slit-lamp photo of the corresponding coin-shaped lesion. Degree of concordance between the confocal microscopic images and slit-lamp photos was evaluated. Results In both eyes, a two-dimensional reconstruction map of the owl’s eye cells was created by computer software using acquired confocal images; the maps showed circular patterns. Superimposing montage images of owl’s eye cells onto the photos of a coin-shaped lesion showed good concordance in the two eyes. Conclusions This study suggests that there is an association between owl’s eye cells observed by confocal microscopy and coin-shaped lesions observed by slit-lamp biomicroscopy in patients with CMV corneal Endotheliitis. The use of in vivo laser confocal microscopy may provide clues as to the underlying causes of CMV corneal Endotheliitis.
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mapping owl s eye cells of patients with cytomegalovirus corneal Endotheliitis using in vivo laser confocal microscopy
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Kazuhisa SugiyamaAbstract:Purpose To produce a two-dimensional reconstruction map of owl’s eye cells using in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal Endotheliitis, and to demonstrate any association between owl’s eye cells and coin-shaped lesions observed with slit-lamp biomicroscopy.
Soonphaik Chee - One of the best experts on this subject based on the ideXlab platform.
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Optimising graft survival in endothelial keratoplasty for endothelial failure secondary to cytomegalovirus Endotheliitis
Journal of Ophthalmic Inflammation and Infection, 2019Co-Authors: Milton C. Chew, Soonphaik Chee, Lim LiAbstract:Background There is limited information regarding Descemet stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to cytomegalovirus (CMV) Endotheliitis. Treatment is difficult with high recurrence rates. We describe a case when systemic valganciclovir therapy is directed by aqueous CMV-DNA levels, leading to good graft survival. Findings A 59-year-old male with bilateral CMV Endotheliitis despite antiviral therapy developed endothelial failure and underwent DSAEK. Prior to surgery, aqueous polymerase chain reaction (PCR) for CMV was repeatedly performed, where CMV-positive episodes were treated with systemic valganciclovir. Monthly aqueous analysis was performed until CMV-DNA was undetectable before DSAEK was performed. Post-operative prophylactic systemic valganciclovir treatment was instituted and switched to topical valganciclovir treatment when aqueous samples were negative for CMV. Conclusion Targeted aqueous sampling for CMV-DNA perioperatively guides antiviral therapy and ensures adequacy of treatment, minimising the duration of systemic valganciclovir therapy to reduce adverse effects of long-term treatment.
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outcomes of corneal transplantation for irreversible corneal decompensation secondary to corneal Endotheliitis in asian eyes
American Journal of Ophthalmology, 2013Co-Authors: Soonphaik Chee, Jodhbir S MehtaAbstract:Purpose To describe outcomes of corneal transplantation for irreversible corneal decompensation from corneal Endotheliitis in Asian eyes. Design Retrospective, observational case series. Methods 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 900 mg twice daily, topical ganciclovir 0.15% 5 applications per day, for 6 weeks) with complete resolution of ocular inflammation, and quiescence for at least 6 months before corneal transplantation. Our main outcome measure was recurrence of Endotheliitis within 1 year after corneal transplantation. Results 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 10 months (range 3-11 months) after corneal transplantation. After successful anti-CMV treatment, all 5 CMV-positive eyes then continued to have clear grafts for a median duration of 21 months (range 13-44 months). Conclusion 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.
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treatment outcome and risk factors for visual loss in cytomegalovirus Endotheliitis
Graefes Archive for Clinical and Experimental Ophthalmology, 2012Co-Authors: Soonphaik CheeAbstract:Background To determine treatment outcome and risk factors for visual loss in Cytomegalovirus (CMV) Endotheliitis.
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Treatment outcome and risk factors for visual loss in Cytomegalovirus Endotheliitis
Graefe's Archive for Clinical and Experimental Ophthalmology, 2012Co-Authors: Soonphaik CheeAbstract:Background To determine treatment outcome and risk factors for visual loss in Cytomegalovirus (CMV) Endotheliitis. Methods Retrospective case-note review of all CMV positive Endotheliitis patients seen at the Singapore National Eye Center, for demographics, visual acuity (VA), extent of corneal edema, anterior chamber (AC) activity, ocular history, glaucomatous optic neuropathy (GON), and ganciclovir therapy. Outcome measures were VA, corneal edema, and AC activity. Results Median age at diagnosis of the 19 patients (21 eyes) was 57 years. Median duration of follow up was 37 months. Sixteen eyes received systemic ganciclovir, and four eyes received ganciclovir gel. The AC inflammation resolved in 19 eyes. The corneal edema resolved in eight eyes, but persisted in 12 eyes. One patient resolved spontaneously. Pre-treatment corneal edema exceeding 75%, older age, GON, and previous corneal graft were risk factors for persistent corneal edema post treatment ( P =
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immune ring formation associated with cytomegalovirus Endotheliitis
American Journal of Ophthalmology, 2011Co-Authors: Soonphaik CheeAbstract:Purpose To describe immune ring (IR) formation as a manifestation of cytomegalovirus (CMV) Endotheliitis. Design Retrospective observational case series. Methods Review of all consecutive CMV anterior uveitis and Endotheliitis patients seen at the Singapore National Eye Centre for the occurrence of an IR. CMV infection was diagnosed by polymerase chain reaction analysis of the aqueous. Results None of the 72 eyes with CMV anterior uveitis had an IR formation. Four episodes of IR formation were seen in 3 eyes (14.3%) of 21 cases of CMV-positive Endotheliitis. All were unilateral and all 3 patients were human immunodeficiency virus negative middle-aged Chinese males. The IR developed 2 to 7 months after occurrence of the Endotheliitis and the aqueous was positive for CMV during 2 of the episodes of IR formation. In 2 eyes, the IR occurred at the completion of a course of systemic ganciclovir when the aqueous was negative for CMV. The immune rings resolved with combination therapy of topical prednisolone acetate 0.12% and ganciclovir. Patient 1 had a recurrence of the IR 4 months after stopping treatment but again resolved following treatment with ganciclovir and topical corticosteroids. Conclusion Corneal immune rings can occur as a result of CMV infection. Hence CMV infection may have to be considered in such cases.
Yuichi Ohashi - One of the best experts on this subject based on the ideXlab platform.
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Corneal Endotheliitis.
Seminars in ophthalmology, 2020Co-Authors: Takashi Suzuki, Yuichi OhashiAbstract:Corneal Endotheliitis is an intriguing clinical entity manifested by corneal edema, keratic precipitates, and mild anterior chamber reaction, and can be defined as a spectrum of the disorder in which the corneal endothelium is the primary site of the inflammation. The disease etiology consists of accumulating evidence of various viral infections including herpes simplex virus, varicella zoster virus, and cytomegalovirus. Corneal Endotheliitis can be classified clinically into four forms: linear, sectorial, disciform, and diffuse. Antiviral treatment in combination with topical corticosteroids is generally effective to suppress the inflammation; however, irreversible corneal endothelial dysfunction may develop in some cases.
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polymorphisms in cytomegalovirus genotype in immunocompetent patients with corneal Endotheliitis or iridocyclitis
Journal of Medical Virology, 2015Co-Authors: Takashi Suzuki, Tomoyuki Inoue, Takeshi Kobayashi, Yuichi OhashiAbstract:Cytomegalovirus (CMV) that caused corneal Endotheliitis and iridocyclitis in immunocompetent patients was genotyped. The gB type1 was detected in seven Endotheliitis samples (77.8%) and five iridocyclitis samples (100%), and the gB type 3 was detected in two Endotheliitis samples (22.2%). The UL144 type 1 was found in five Endotheliitis samples (45.5%) and five iridocyclitis samples (83.3%). The UL144 type 2 was found in two Endotheliitis samples (18.2%) and one iridocyclitis sample (16.7%). The gB type 1 was predominant in Endotheliitis and iridocyclitis, and the CMV genotypes in eyes with Endotheliitis and iridocyclitis were similar. J. Med. Virol. 87:1441–1445, 2015. © 2015 Wiley Periodicals, Inc.
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clinical features and management of cytomegalovirus corneal Endotheliitis analysis of 106 cases from the japan corneal Endotheliitis study
British Journal of Ophthalmology, 2015Co-Authors: Takashi Suzuki, Yuichi Ohashi, Yoshitsugu Inoue, Noriko Koizumi, Tsutomu Inatomi, Atsushi Shiraishi, Michiko Kandori, Dai Miyazaki, Takeshi SomaAbstract:Aims The purpose of this study is to elucidate the clinical manifestations and the current treatment status of cytomegalovirus (CMV) Endotheliitis via a large case series obtained from a national survey conducted in Japan. Methods The Japan Corneal Endotheliitis Study Group proposed diagnostic criteria for CMV Endotheliitis based on a viral examination by PCR of aqueous humour, in combination with clinical manifestations. A national survey was then retrospectively conducted among 1160 members of the Japan Cornea Society. The study reviewed the patient profiles, clinical manifestations, and treatment modalities of individuals who met the diagnostic criteria for CMV Endotheliitis. Results The study included 109 eyes of 106 patients. Mean patient age was 66.9±10.9 years (85 males (80.2%), 21 females (19.8%)). Patients were commonly diagnosed with anterior uveitis and ocular hypertension prior to confirmation of CMV Endotheliitis. Coin-shaped lesions were observed in 70.6%, and linear keratic precipitates in 8.3% of the patients, respectively. 95% of cases were treated with anti-CMV drugs. Conclusions CMV Endotheliitis is most common in middle-aged and elderly men. CMV Endotheliitis should be suspected when patients present with corneal Endotheliitis involving coin-shaped lesions accompanied by anterior uveitis and ocular hypertension.
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dna of cytomegalovirus detected by pcr in aqueous of patient with corneal Endotheliitis after penetrating keratoplasty
Cornea, 2007Co-Authors: Takashi Suzuki, Yuko Hara, Yuichi OhashiAbstract:Purpose:Corneal Endotheliitis often leads to severe endothelial dysfunction and can be caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and other viruses (eg, the mumps virus). We report a case of corneal Endotheliitis caused by cytomegalovirus (CMV) that developed after a penetra
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demonstration of owl s eye morphology by confocal microscopy in a patient with presumed cytomegalovirus corneal Endotheliitis
American Journal of Ophthalmology, 2007Co-Authors: Atsushi Shiraishi, Takashi Suzuki, Masahiko Yamaguchi, Yuko Hara, Miyabi Takahashi, Yuichi OhashiAbstract:Purpose To report confocal microscopic observations of characteristic corneal endothelial lesions in a patient with presumed cytomegalovirus (CMV) corneal Endotheliitis. Design Case report. Methods A 77-year-old, immunocompetent man was admitted with corneal edema, keratic precipitates, and coin-shaped lesions in the right eye. Confocal microscopy was performed to examine the corneal endothelium. Polymerase chain reaction (PCR) was used to identify viral DNA in an aqueous humor sample. Results CMV DNA was detected by PCR. Confocal microscopy showed large corneal endothelial cells with an area of high reflection in the nucleus surrounded by a halo of low reflection. This “owl’s eye” morphology is characteristic of CMV infection. Topical and intravenous ganciclovir treatment resulted in rapid resolution of the corneal precipitates and edema, followed by disappearance of the owl’s eye morphology. Conclusions Confocal microscopy can detect the owl’s eye morphology in the corneal endothelium of patients with presumed CMV corneal Endotheliitis.
Hideaki Yokogawa - One of the best experts on this subject based on the ideXlab platform.
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in vivo imaging of coin shaped lesions in cytomegalovirus corneal Endotheliitis by anterior segment optical coherence tomography
Cornea, 2014Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Kazuhisa SugiyamaAbstract:Abstract The aim of this study was to investigate in vivo corneal changes of coin-shaped lesions in cytomegalovirus corneal Endotheliitis using anterior segment optical coherence tomography (AS-OCT). Two eyes of 2 patients (69- and 71-year-old men), with polymerase chain reaction-proven CMV corneal Endotheliitis presenting coin-shaped lesions, were included in this study. AS-OCT examination was performed on the initial visit and at follow-up visits by paying special attention to the coin-shaped lesions. Selected AS-OCT images of the cornea were evaluated qualitatively for changes in the shape and degree of light reflection. In both cases, coin-shaped lesions were observed at the corneal endothelial surface as clusters of fine precipitates using slit-lamp biomicroscopy. Using AS-OCT, high-resolution images of the putative coin-shaped lesions were successfully obtained in both patients as an irregularly thickened highly reflective endothelial cell layer. After anti-CMV treatment, the coin-shaped lesions were resolved as assessed by slit-lamp biomicroscopy and AS-OCT in both patients. High-resolution AS-OCT provides novel and detailed visual information of coin-shaped lesions in patients with CMV corneal Endotheliitis. Visualization of coin-shaped lesions by AS-OCT may be a useful adjunct to the diagnosis and follow-up of CMV corneal Endotheliitis.
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Identification of cytomegalovirus and human herpesvirus-6 DNA in a patient with corneal Endotheliitis
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Kazuhisa SugiyamaAbstract:Purpose To report the case of a patient with unilateral corneal Endotheliitis in which both cytomegalovirus (CMV) and human herpesvirus-6 (HHV6) DNA was identified in the aqueous humor. Case A 67-year-old man with corneal Endotheliitis OD was referred to us for decreased visual acuity. Local corneal stromal edema, pigmented keratic precipitates, a coin-shaped lesion and minimal anterior chamber reaction were observed by slit-lamp biomicroscopy. Cells with owl’s eye appearance in the endothelial cell layer were observed by in vivo laser confocal microscopy. The patient had rheumatoid arthritis, which was treated by oral prednisolone and intravenous abatacept. Polymerase chain reaction analysis of aqueous humor samples detected both CMV and HHV6 DNA, but not other HHVs. Treatment with topical ganciclovir and systemic valganciclovir resulted in a clear cornea. Conclusions A patient with corneal Endotheliitis had both CMV and HHV6 DNA identified in the aqueous humor. Although both viruses were identified in this case, clinical manifestations resembled CMV corneal Endotheliitis, and it was unclear whether HHV6 could affect the clinical course. Systemic abatacept and corticosteroid therapy might play a positive role in cases with both CMV and HHV6 DNA in this corneal Endotheliitis.
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identification of cytomegalovirus and human herpesvirus 6 dna in a patient with corneal Endotheliitis
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Kazuhisa SugiyamaAbstract:Purpose To report the case of a patient with unilateral corneal Endotheliitis in which both cytomegalovirus (CMV) and human herpesvirus-6 (HHV6) DNA was identified in the aqueous humor.
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Mapping owl’s eye cells of patients with cytomegalovirus corneal Endotheliitis using in vivo laser confocal microscopy
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Kazuhisa SugiyamaAbstract:Purpose To produce a two-dimensional reconstruction map of owl’s eye cells using in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal Endotheliitis, and to demonstrate any association between owl’s eye cells and coin-shaped lesions observed with slit-lamp biomicroscopy. Method Two patients (75- and 77-year-old men) with polymerase chain reaction-proven CMV corneal Endotheliitis were evaluated in this study. Slit-lamp biomicroscopy and in vivo laser confocal microscopy were performed. Images of owl’s eye cells in the endothelial cell layer were arranged and mapped into subconfluent montages. Montage images of owl’s eye cells were then superimposed on a slit-lamp photo of the corresponding coin-shaped lesion. Degree of concordance between the confocal microscopic images and slit-lamp photos was evaluated. Results In both eyes, a two-dimensional reconstruction map of the owl’s eye cells was created by computer software using acquired confocal images; the maps showed circular patterns. Superimposing montage images of owl’s eye cells onto the photos of a coin-shaped lesion showed good concordance in the two eyes. Conclusions This study suggests that there is an association between owl’s eye cells observed by confocal microscopy and coin-shaped lesions observed by slit-lamp biomicroscopy in patients with CMV corneal Endotheliitis. The use of in vivo laser confocal microscopy may provide clues as to the underlying causes of CMV corneal Endotheliitis.
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mapping owl s eye cells of patients with cytomegalovirus corneal Endotheliitis using in vivo laser confocal microscopy
Japanese Journal of Ophthalmology, 2013Co-Authors: Hideaki Yokogawa, Akira Kobayashi, Kazuhisa SugiyamaAbstract:Purpose To produce a two-dimensional reconstruction map of owl’s eye cells using in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal Endotheliitis, and to demonstrate any association between owl’s eye cells and coin-shaped lesions observed with slit-lamp biomicroscopy.
