Long-term outcome of patients with cytomegalovirus-induced anterior uveitis treated with antiviral therapy.

Abstract

Purpose: Cytomegalovirus (CMV)-induced uveitis are usually resistant to conventional treatment (topical corticosteroids, anti-glaucoma medications) and can lead to recurrences or secondary glaucoma. The purpose of this study is to describe the long-term outcome of specific anti-CMV therapy on different clinical features of cytomelagovirus-induced anterior uveitis in immunocompetent patients.

Methods: This retrospective study includes immunocompetent patients with PCR-proven CMV anterior segment infection, managed between 2002 and 2009 at Pitié-Salpétrière hospital in Paris, France. Two different clinical presentations were identified : Posner Schlossman-like (PSS) uveitis and presumed viral uveitis (PVU). All patients were treated with an induction course of antiviral treatment (intravenous ganciclovir for 7 days or oral valganciclovir for 3 weeks) followed by a maintenance dose of valganciclovir for a total period of 3 months. Intra ocular pressure (IOP), number of relapses and glaucoma surgery were assessed.

Results: We included 36 consecutive patients with a mean follow-up of 39 months. 24 patients (67%) had PSS uveitis and 12 patients (33%) had PVU. Corticosteroids were uneficcient in 14 patients (7 PSS and 7 PVU). Mean IOP during flare-up was 30mmHg under an average of 2.7 anti-IOP drugs. 20 patients were treated with iv ganciclovir and 16 patients with oral valganciclovir. Then all patients received maintenance dose of valganciclovir. Mean IOP after 1 month antiviral treatment was 16mmHg with an average of 1 anti-IOP drug. No patient relapsed during antiviral treatment. At the end of follow up 10 patients (28%) were on remission, even without antiviral treatment or corticosteroids, 7 other patients (19%) were on low dose valganciclovir (≤450mg/day) without any relapse and 9 patients were stable with valganciclovir gel. Five patients underwent glaucoma surgery. Relapses occurred in a median time of 5 months (range 1-93 months) after the end of treatment. Mean number of reccurences was 2.2 (about 1 per year) after treatment. Oral valganciclovir seemed to have the same efficacy than iv ganciclovir. Topical valganciclovir gel was useful in preventing recurrences but not for the acute phase of infection with viral replication.

Conclusions: Specific anti-CMV therapy can control CMV anterior uveitis by improving IOP, anterior inflammation and can decrease or delay relapses.

Keywords: 746 uveitis-clinical/animal model • 492 cytomegalovirus • 425 antiviral drugs