Abstract
Purpose :
There has been no consensus on the treatment of CMV AU with uncontrolled IOP despite maximal topical medications. This retrospective case series described the efficacy and safety of trabeculectomy with mitomycin-C(MMC) in these patients, and compared it with previously published efficacy data on oral valganciclovir.
Methods :
Forty-one eyes of 41 CMV AU patients received either trabeculectomy with MMC(n=30) or a single course(20-148 days) of oral valganciclovir (n=17) for uncontrolled IOP, with 6 in the latter requiring subsequent trabeculectomy. Clinical information, IOP and use of IOP-lowering medication/steroid at baseline and every 3 months over 2 years post intervention were recorded. Survival endpoint was defined as further intervention for uncontrolled IOP(glaucoma surgery or another course of valganciclovir). Treatment success was defined as IOP ≤21 mmHg with same or less IOP-lowering medications compared to baseline, without systemic acetazolamide or reaching survival endpoint.
Results :
For those receiving trabeculectomy, median IOP significantly dropped from 24.1(IQR: 20.5, 32.0)mmHg at baseline to 13.0(10.3, 16.2)mmHg at 24 months, while on 5.0(5.0, 5.0) and 0.0(0.0, 0.8) IOP-lowering medications, respectively, with up to 72.2% IOP reduction(Wilcoxon sign-rank test, p<0.01 at all time points).Treatment success was 80% at 24 months. Those with history of/concomitant intraocular operation had shorter survival(18.8 months versus 23.5 months, log-rank test, p=0.041, Fig.1). 53.5% and 30.0% had hypotony and wound leak, respectively, with no serious sequelae.
In the first interventions for IOP control (n=38, either trabeculectomy or valganciclovir), female, history of endotheliitis and systemic acetazolamide use at baseline were associated with longer survival compared to their counterparts(p=0.035, 0.046, 0.034, respectively). After excluding one eye with prolonged valganciclovir use post-trabeculectomy, trabeculectomy group(n=22) had higher chance for treatment success at 24 months than valganciclvoir group(n=15)(OR: 6.8, 95% C.I.:1.5 to 30.2), longer survival(21.9 months versus 13.6 months, p=0.003, Fig 2), but less %reduction in steroid use(Fisher’s exact test: p=0.018).
Conclusions :
Trabeculectomy with MMC is efficacious and safe for IOP control in CMV AU, with higher success than oral valganciclovir but less %reduction in steroid.
This is a 2021 ARVO Annual Meeting abstract.