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Taniya Bhoopat, John Alexander Gonzales; Cytomegalovirus Anterior Uveitis: Description and Treatment Outcomes in a Tertiary Center in North America. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4180.
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Cytomegalovirus (CMV) is increasingly recognized as an important cause of anterior uveitis. Most studies have come from Asia and Europe. While there is no well-defined treatment for CMV anterior uveitis (CMV-AU), oral valganciclovir has been the main treatment. We report on the clinical findings and long-term treatment outcomes of patients with CMV-AU from a tertiary uveitis clinic in North America.
Retrospective review of medical records of all CMV-AU cases from the Francis I. Proctor Foundation between 2002 and 2014 was performed. Demographic data and clinical findings were collected. Changes in visual acuity (VA), anterior chamber (AC) inflammation, and intraocular pressure (IOP) at baseline, 6 months, and 1 year follow-up were compared using a t-test to evaluate treatment outcomes.
Eighteen eyes of 16 patients were diagnosed as CMV-AU and treated with oral valganciclovir. The mean age was 41 years (range 13-69 years), with 9 males and 7 females. Twelve were Asian (75%) and 4 were Caucasian. Thirteen eyes (72%) presented with best corrected VA of 20/40 or better and 7 eyes (39%) had a history of recurrent hypertensive anterior uveitis. Seven eyes (39%) had corneal edema and 6 eyes (33%) had iris atrophy. All eyes had keratic precipitates (KPs) though circinate KPs were found in only 4 eyes (22%). Statistical analyses did not show a correlation between IOP, iris atrophy, AC inflammation and VA. AC cell improved significantly at 6 months follow-up (p < 0.001) and 1 year follow-up (p = 0.002). The mean logMAR VA improved significantly from 0.30 to 0.10 at 1 year follow-up (p = 0.011). The mean IOP decreased significantly at 6 month follow-up (p = 0.025). Of the fifteen eyes that have follow-up data, 11 eyes (73%) had recurrence of inflammation, 6 of which recurred on a prophylactic dose of valganciclovir. Five eyes (33%) flared after stopping valganciclovir. Eight eyes (53%) had glaucoma with 3 requiring glaucoma surgery. Only one patient exhibited pancytopenia as an adverse side effect which improved after cessation of antiviral medication.
Valganciclovir appeared to be effective and safe in treatment of CMV-AU in a North American tertiary uveitis clinic. However, treatment required long-term use and recurrences may occur even with prophylactic dosing.
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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