Effectiveness of Topical Ganciclovir 2% Monotherapy Versus Combined Steroid Therapy in Cytomegalovirus Endotheliitis

We aimed to report the clinical manifestations of cytomegalovirus (CMV) corneal endotheliitis and the results of long-term treatment with topical ganciclovir 2% with and without steroids. This retrospective, interventional study included 15 eyes of 13 patients diagnosed with CMV corneal endotheliitis by positive CMV DNA and treated with long-term topical ganciclovir 2% eye drops at a tertiary referral center and the median follow-up period was 17 months. Ocular manifestations included keratic precipitates (KPs) (100%), elevated IOP (93.3%), iritis (60%), corneal edema (60%), and moth-eaten iris atrophy (60%). After long-term treatment, corneal edema, iritis, and KPs significantly decreased (effect size: 72%, 76% and 70%, respectively; p = 0.024, p = 0.006 and p < 0.001, respectively). Both the logMAR acuity and IOP significantly improved (median logMAR was 0.52 before treatment and 0.22 after treatment; median IOP was 42 mmHg before treatment and 12 mmHg after treatment; p = 0.001 and p < 0.001, respectively). The ECD was maintained (effect size: 80%), and the percentage of hexagonal cell ratio of endothelial cells significantly improved after treatment (effect size: 82%; p = 0.035). Fewer anti-glaucoma medications were used in the non-steroid group (effect size: 79%; p = 0.034). Long-term maintenance treatment with topical ganciclovir 2% monotherapy not only provides effective therapy and reduces recurrence, but also decreases the high IOP related to the combination of steroids used.