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

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

doi:10.1007/s10792-020-01412-6

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

Int Ophthalmol. 2020 Sep;40(9):2297-2305. doi: 10.1007/s10792-020-01412-6. Epub 2020 May 16.

Authors

Ayano Yoshimura^{1

2}, Kaoru Araki-Sasaki^{3

4

5}, Noriko Toyokawa⁶, Rho Fujiwara^{1

7}, Nobuo Jho⁸, Fumi Gomi²

Affiliations

¹ Japan Health Care Organization, Hoshigaoka Medical Center, Hirakata, Japan.
² Department of Ophthalmology, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
³ Japan Health Care Organization, Hoshigaoka Medical Center, Hirakata, Japan. sasakis@sa2.so-net.ne.jp.
⁴ Nagata Eye Clinic, Nara, Japan. sasakis@sa2.so-net.ne.jp.
⁵ Department of Ophthalmology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 5731010, Japan. sasakis@sa2.so-net.ne.jp.
⁶ Nagata Eye Clinic, Nara, Japan.
⁷ Department of Ophthalmology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 5731010, Japan.
⁸ Jho Eye Clinic, Hirakata, Japan.

Abstract

Purpose: To 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.

Methods: We 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.

Results: There 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.

Conclusions: Careful 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.

Keywords: Coin-shaped lesion; Corneal endotheliitis; Cytomegalovirus; Keratic precipitates; Sectoral corneal edema.

MeSH terms

Antiviral Agents / therapeutic use
Aqueous Humor
Cytomegalovirus / genetics
Cytomegalovirus Infections* / diagnosis
Cytomegalovirus Infections* / drug therapy
DNA Copy Number Variations
DNA, Viral / genetics
Endothelium, Corneal
Eye Infections, Viral* / diagnosis
Eye Infections, Viral* / drug therapy
Humans
Real-Time Polymerase Chain Reaction

Substances

Antiviral Agents
DNA, Viral