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He LH, Qu JH, Peng RM, Zang YX, Xiao GG, Hong J. Clinical Manifestations and Long-term Outcomes of Endothelial Keratoplasty in Patients with Proven VZV-related Endothelial Decompensation. Ocul Immunol Inflamm 2023; 31:348-354. [PMID: 35050835 DOI: 10.1080/09273948.2022.2028292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the clinical manifestations, postoperative complications and long-term outcomes of endothelial keratoplasty in VZV-related endothelial decompensation. METHODS In this retrospective study, thirteen eyes undergoing endothelial keratoplasty (EK) for VZV-related endothelial decompensation were compared with controls for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. RESULTS Twelve patients did not have typical dermal pain or blisters. Ten patients had obvious iris abnormalities. Glaucoma was noted in eight patients before surgery. The best spectacle-corrected visual acuity improved from 1.12 ± 0.47 to 0.39 ± 0.43 (p = .002), whereas endothelial cell (EC) loss was 65% ±15% at 12 months that higher than that in the controls (p < .05). Postoperative complications included graft detachment (2/13), recurrence of endotheliitis (3/13), neurotrophic ulcer (1/13) and scleritis (1/13). CONCLUSIONS The onset of VZV-related endothelial decompensation is generally insidious. Iris segmental atrophy, glaucoma and pigment KPs are highly suspected to be associated with VZV. EK is a reasonable option to rehabilitate vision.
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Affiliation(s)
- Lin-Hui He
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing-Hao Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yun-Xiao Zang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Ge-Ge Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Wintergerst MWM, Liu X, Terheyden JH, Pohlmann D, Li JQ, Montesano G, Ometto G, Holz FG, Crabb DP, Pleyer U, Heinz C, Denniston AK, Finger RP. Structural Endpoints and Outcome Measures in Uveitis. Ophthalmologica 2021; 244:465-479. [PMID: 34062542 DOI: 10.1159/000517521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
Most uveitis entities are rare diseases but, taken together, are responsible for 5-10% of worldwide visual impairment which largely affects persons of working age. As with many rare diseases, there is a lack of high-level evidence regarding its clinical management, partly due to a dearth of reliable and objective quantitative endpoints for clinical trials. This review provides an overview of available structural outcome measures for uveitis disease activity and damage in an anatomical order from the anterior to the posterior segment of the eye. While there is a multitude of available structural outcome measures, not all might qualify as endpoints for clinical uveitis trials, and thorough testing of applicability is warranted. Furthermore, a consensus on endpoint definition, standardization, and "core outcomes" is required. As stipulated by regulatory agencies, endpoints should be precisely defined, clinically important, internally consistent, reliable, responsive to treatment, and relevant for the respective subtype of uveitis. Out of all modalities used for assessment of the reviewed structural outcome measures, optical coherence tomography, color fundus photography, fundus autofluorescence, and fluorescein/indocyanine green angiography represent current "core modalities" for reliable and objective quantification of uveitis outcome measures, based on their practical availability and the evidence provided so far.
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Affiliation(s)
| | - Xiaoxuan Liu
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Dominika Pohlmann
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Giovanni Montesano
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Giovanni Ometto
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Uwe Pleyer
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Zhang S, Xiao G, Peng RM, Zhang P, Hong J. Clinical consequences of herpes simplex virus DNA in donor corneas: Different prognosis and management of endothelial keratoplasty and deep anterior lamellar keratoplasty. J Clin Virol 2020; 129:104508. [PMID: 32554307 DOI: 10.1016/j.jcv.2020.104508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/24/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is still controversy over the necessity of screening donor corneas for herpes simplex virus (HSV). Currently, no study reported the outcomes of different types of keratoplasty with HSV-positive donor corneas. OBJECTIVES To describe the clinical consequences of four patients who underwent keratoplasty by sharing double corneas from a single donor, both of which were positive for HSV-1 DNA by polymerase chain reaction. STUDY DESIGN A retrospective case series study. RESULTS Both patients who underwent endothelial keratoplasty (EK) developed persistent corneal edema with or without keratic precipitates, and mild anterior chamber inflammation on postoperative day 3 and 17 respectively. Despite adequate antiviral treatment, they developed graft detachment subsequently and experienced graft replacement. Transmission electron microscopy showed denuded Descemet's membrane without any endothelial cells on both removed grafts and viral particles were identified within the residual posterior stroma of the thicker graft. As for those who underwent deep anterior lamellar keratoplasty, one patient presented with graft rejection for the sake of self-discontinuation of all anti-rejection agents. The other's graft remained clear at the final follow-up. CONCLUSIONS HSV existed in the posterior stromal and endothelial layer of the donor corneas. Reactivation of HSV and severe endothelial loss may occur on corneal endothelial grafts in the early postoperative period while anterior lamellar grafts could be quiescent. Considering the possibility of graft failure caused by viral reactivation, it's of great significance to screen for viral DNA in donor corneas prior to the surgery, especially for EK.
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Affiliation(s)
- Shuang Zhang
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education. No. 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education. No. 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education. No. 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Pei Zhang
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education. No. 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education. No. 49 North Garden Road, Haidian District, Beijing 100191, China.
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Peng RM, Guo YX, Xiao GG, Li CD, Hong J. Characteristics of Corneal Endotheliitis among Different Viruses by in Vivo Confocal Microscopy. Ocul Immunol Inflamm 2019; 29:324-332. [PMID: 31697212 DOI: 10.1080/09273948.2019.1678648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To explore the cellular morphological characteristics and changes in corneal endotheliitis among different viruses by in vivo confocal microscopy (IVCM).Methods: Corneal confocal images of 44 eyes of 44 patients with HSV, VZV, CMV and EBV corneal endotheliitis were studied retrospectively. Corneal confocal images of 44 normal eyes were used as controls.Results: The pathogens included cytomegalovirus (n = 20), herpes simplex virus (n = 8), varicella zoster virus (n = 10), and Epstein Barr virus (n = 6). There were no differences in the evaluated structures among the different viruses except for the lengths of the subbasal nerves and Langerhans cell densities. Deviations in endothelial cell layers were not significant among different viruses except for owl's eye morphology.Conclusion: ICVM can assist in diagnosing endotheliitis. The results demonstrate that changes in the cornea were not different among the various viruses except for owl's eye morphology, the lengths of the subbasal nerves and Langerhans cell densities.
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Affiliation(s)
- Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yu-Xin Guo
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Ge-Ge Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Chen-Di Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
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Yu T, Peng RM, Xiao GG, Feng LN, Hong J. Clinical Evaluation of Intravitreal Injection of Ganciclovir in Refractory Corneal Endotheliitis. Ocul Immunol Inflamm 2019; 28:270-280. [PMID: 30806530 DOI: 10.1080/09273948.2019.1573261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the efficacy and safety of intravitreal ganciclovir (GCV) injection in refractory endotheliitis.Methods: Retrospectively recruited 25 eyes with endotheliitis, proved by clinical manifestations, positive PCR for viral DNA and responded poor to topical and systemic antiviral medications. All patients received additional continued intravitreal GCV injections.Results: Cytomegalovirus (CMV), varicella zoster virus (VZV), and herpes simplex virus (HSV) DNA were detected in 64.0%, 28.0%, and 8.0% of the eyes, respectively. Within 2 weeks after the last injection, 16/25 eyes recovered corneal clarity; active keratic precipitates (KPs) were eliminated in 21/25 eyes; intraocular pressure (IOP) was controlled in 12/15 eyes with elevated IOP on study entry. Best-corrected visual acuity increased at the last follow-up (p = 0.016). Clinical recurrence occurred in three patients. No complications were detected.Conclusions: CMV endotheliitis was the main type of refractory endotheliitis. Despite its invasive nature, intravitreal GCV injection appears to be an effective method for refractory endotheliitis.
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Affiliation(s)
- Ting Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Vision Loss and Restoration of Damaged Ocular Nerve, Ministry of Education, Beijing, China
| | - Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Vision Loss and Restoration of Damaged Ocular Nerve, Ministry of Education, Beijing, China
| | - Ge-Ge Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Vision Loss and Restoration of Damaged Ocular Nerve, Ministry of Education, Beijing, China
| | - Li-Na Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Vision Loss and Restoration of Damaged Ocular Nerve, Ministry of Education, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Vision Loss and Restoration of Damaged Ocular Nerve, Ministry of Education, Beijing, China
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Cho YW, Lee DW, Kim GN, Kim HA, Kim SJ. Clinical Manifestations and Outcomes of Varicella-zoster Virus Endotheliitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Wun Cho
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Dong Woo Lee
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Gyu Nam Kim
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
| | - Hyun-A Kim
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
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