Early initiation of antiviral therapy benefits patients with CMV-associated anterior uveitis

Investigators of this consecutive case series report the characteristics of cytomegalovirus (CMV)-associated anterior uveitis and compared response with 2 types of antiviral treatments.

Study design

The retrospective study included 36 eyes of 35 patients from France who were immunocompetent with polymerase chain reaction–positive CMV anterior uveitis. All patients received an induction dose of IV ganciclovir or oral valganciclovir, and were maintained on oral valganciclovir. Response was defined as resolution of inflammation (anterior chamber cells and keratic precipitates) and IOP control with or without glaucoma therapy during the course of treatment.

Outcomes

Patients presented as Posner-Schlossman and chronic nonspecific anterior uveitis in 69% and 31% of cases, respectively.

All patients responded to the first-line treatment with oral valganciclovir vs. 90.4% with IV ganciclovir. After treatment, the number of yearly posttreatment flare-ups showed a dramatic decrease regardless of induction treatment. Vision improved over the follow-up period, but did not reach statistical significance (P=0.07 vs. baseline). Both IOP and the number of antiglaucoma drops showed significantly improvement (both P<0.05). Eight patients (38.1%) in the IV group and 1 patient (7.1%) in the oral therapy group required glaucoma surgery.

Limitations

The study was limited by a small number of patients, and was not specifically designed to compare different types of treatments. There was a selection bias toward more severe cases because study was conducted in third-line care unit.

Clinical significance

Early initiation of either IV or oral valganciclovir (<700 days) was effective in controlling inflammation. The therapy improved vision, decreased IOP and number of attacks/flare-ups, as well as reduced rates of recurrence and glaucoma surgery requirement in immunocompetent patients with CMV-associated anterior uveitis.