Abstract
Purpose :
Cytomegalovirus anterior uveitis (CMV-AU) is a challenging disease to diagnose, and delayed diagnosis often leads to corneal endothelial cell loss and the progression of glaucoma due to sustained high intraocular pressure. Oral treatment with valganciclovir is useful, but continuous therapy results in systemic side effects such as bone marrow suppression and renal failure. Recently, it has been reported that 2% ganciclovir (GCV) eye drops are effective for the treatment of CMV-AU. In this study, we investigated the efficacy and safety of 2% GCV eye drops for the treatment of CMV-AU.
Methods :
Medical records of nine patients with CMV-AU who were treated with 2% GCV eye drops at the National Defense Medical College Hospital from October 2020 to August 2023 were retrospectively reviewed for patient background, ocular findings at the initial and final visits, and treatment course.
Results :
All nine patients had unilateral CMV-AU, with an average age of 70.6 ± 12.2 years and a male-to-female ratio of 8:1. The average follow-up period at the referring medical institution was 61.7 ± 90.2 months, and that at our hospital was 14.4 ± 9.9 months. All patients were prescribed topical corticosteroids and anti-glaucoma eye drops. CMV-DNA was detected in the aqueous humor of 6 patients in the first PCR test and 2 patients in the second PCR test. In total, 8 patients (88.9%) were found to be positive for CMV-DNA. After the initiation of 2% GCV eye drops, recurrence of uveitis did not occur in 3 patients (33.3%), but was observed in the remaining 6 patients (66.7%). For recurrence of uveitis, GCV was administered orally in 5 patients and intravenously in 1 patient. LogMAR and intraocular pressure (IOP) at the initial visit were 0.58 ± 0.97 and 22.5 ± 7.0 mmHg, respectively, and improved to 0.13 ± 0.42 and 17.5 ± 8.3 mmHg at the final visit, although not significantly. The corneal endothelial cell count decreased slightly from 2020 ± 453 cells/mm2 to 2006 ± 803 cells/mm2, but there was no significant difference. Two patients (22.2%) underwent glaucoma surgery during the follow-up. At the final visit, 5 patients (55.6%) were still prescribed topical anti-glaucoma eye drops. All patients continued to use 2% GCV eye drops without any adverse events.
Conclusions :
These results suggest that 2% GCV eye drops are effective in suppressing the recurrence of CMV-AU and reducing the need for systemic administration of GCV.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.