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Sara Touhami, Lise Qu, Magdalena Bozhanova, Flore Rozenberg, Phuc Lehoang, Bahram Bodaghi; Cytomegalovirus Anterior Uveitis: Characteristics and Outcomes in Caucasian Patients.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4179. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the characteristics and outcomes of Cytomegalovirus anterior uveitis (CMV AU) in caucasian patients and its comparative response to two types of antiviral induction treatments.
Monocentric retrospective study. Consecutive immunocompetent patients with PCR proven CMV AU with a follow-up>1 year were included between 2002 and 2013. For each patient, best corrected visual acuity (BCVA), intraocular pressure (IOP), clinical characteristics at baseline and latest visit, and number of relapses were recorded. All patients received systemic antiviral treatment consisting in an induction dose (IV Ganciclovir or oral Valganciclovir) and a maintenance dose (oral Valganciclovir).
Thirty six eyes of 35 patients (22 men, 13 women) were included. Patients' characteristics: mean age at diagnosis was 55.5 years. Mean follow-up duration was 4.13 years. Posner Schlossmann, non specific AU (NS AU), Fuchs syndrome and endotheliitis were observed in 69.4%, 30.6%, 0% and 0% of cases. At baseline, mean BCVA was 20/25. Keratic precipitates and iris atrophy were observed in 91.4% and 25.7% of cases. Mean initial IOP was 29.19 mmHg requiring on average 1.97 types of antiglaucoma drops. Visual field defects were reported in 52.9% of cases at baseline. Glaucoma surgery was necessary in 25.7% of cases. Early initiation of antiviral therapy (≤700 days) decreased the recourse to glaucoma surgery (8,3% versus 34,7% for the subgroups ≤700 and >700days). Induction therapy consisted in oral Valganciclovir and IV Ganciclovir in 40% and 60% of cases. The mean duration of maintenance therapy was 6.16 months. 94.2% of patients responded to the first line of therapy. Recurrence was reported in 73.5% of cases. Maintenance therapy > 6 months did not seem to reduce the number of recurrences. Comparative response to treatments: Both induction treatments seemed similar in terms of BCVA changes and decrease in the number of relapses. Higher rates of glaucoma surgery were recorded in the IV induction subgroup.
Characteristics of CMV AU seem to show specificities in caucasian patients. Early initiation of antiviral therapy seems to reduce the severity of glaucoma. Duration of maintenance therapy does not seem to decrease recurrences beyond 6 months. CMV AU of the immunocompetent is a potentially blinding entity that requires early diagnosis and treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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