Ophthalmology and Therapy (May 2024)

Incidence of Cytomegalovirus Infection After Repeat Keratoplasty and Associated Rate of Graft Failure

  • Yunxiao Zang,
  • Yaning Zhao,
  • Rongmei Peng,
  • Gege Xiao,
  • Xiaozhen Liu,
  • Yi Qu,
  • Xuanjun Zhang,
  • Jiaxin Zhang,
  • Jing Hong

DOI
https://doi.org/10.1007/s40123-024-00968-1
Journal volume & issue
Vol. 13, no. 7
pp. 1967 – 1980

Abstract

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Abstract Introduction The aim of this work was to compare the prognosis and characteristics of patients with Cytomegalovirus (CMV) infection (CMV+) with those of patients without virus infection (Virus–) undergoing repeat keratoplasty. Methods This prospective propensity score-matched cohort study enrolled patients who underwent repeat keratoplasty for graft failure at the Peking University Third Hospital between January 2016 and May 2022. Patients with prior viral keratitis before the first keratoplasty were excluded. The primary outcome measure was the graft failure rate. The secondary outcome measures included the anterior segment characteristics, intraocular pressure (IOP), and endothelial cell density. Results Ninety-four matched patient pairs were included. The graft failure rate in the CMV+ group (71%) was higher than that in the Virus– group (29%) (P < 0.001). CMV infection in the cornea increased the risk of repeat graft failure and shortened the median survival time (hazard ratio, 3.876; 95% confidence intervals, 2.554–5.884; P < 0.001). The characteristics of graft failure included exacerbation of ocular surface inflammation, neovascularization, and opacification. Epithelial defects, high IOP, and endothelial decompensation were observed at an increased frequency in the CMV+ group (all P < 0.005). Recurrent CMV infection presented as early endothelial infection in the CMV+ group. Recurrence of CMV infection was confined to the graft endothelium without involving the stroma and epithelium post-repeat endothelial keratoplasty. Conclusions CMV infection post-keratoplasty leads to persistent endothelial damage and graft opacification and significantly increases the risk of repeat graft failure. Localized recurrence of CMV infection in the endothelial grafts underscores the importance of monitoring and treatment. Trial Registration Chictr.org.cn, ChiCTR1800014684.

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