Diagnosis and management of cytomegalovirus anterior uveitis/endothelitis in immunocompetent patients in 2 European referral centers

Abstract

PurposeTo evaluate the methods leading to the diagnosis of CMV anterior uveitis (AU) and/or endotheliitis from 2 uveitis tertiary referrals centers and to assess the outcome after topical ganciclovir treatment.MethodsRetrospective study of patients with a clinical and biological diagnosis of CMV AU/endothelitis demonstrated by a positive polymerase chain reaction (PCR) and/or Goldmann‐Witmer coefficient (GWc). The Belgian patients were treated with topical ganciclovir once the biological diagnosis was confirmed. The number of recurrences was evaluated in the pre‐ and post‐treatment period.ResultsWe report a series of 21 patients (15 from Brussels and 6 from Utrecht) presenting clinical characteristics of CMV AU and/or endothelitis with a positive PCR and/or GWc for CMV. PCR was positive in 15/21 (71.4%) patients, while GWc was positive in 8/9 (88.9%), including 6 patients initially tested for PCR and GWc and 3 secondary tested for GWc when the PCR was negative. 2/9 patients (22.2%) were GWc+/PCR+, 6/9 patients (66.7%) GWc+/PCR‐ and 1/9 patient was GWc‐/PCR+ (11.1%). Aqueous tap was repeated in 9 of the 15 Belgian patients (60%) (2 times in 6 cases, 3 times in 3 cases) to get the biological confirmation of CMV AU/endothelitis. Mean follow up duration was respectively 19.2 ± 23.8 and 46.7 ± 29.7 months in the pre‐ and post‐treatment period. Patients had a significantly lower number of recurrences/year post‐treatment (0.76 ± 0.57) than in the pre‐treatment period (3.76 ± 2.44) (p = 0.001).ConclusionsRepeated aqueous taps in order to perform PCR and GWc were found to be helpful to confirm biologically the clinical diagnosis of CMV AU/ endothelitis. Our results also suggest that patients with topical ganciclovir have a decreased frequency of CMV‐AU/endotheliitis recurrence and keep a relatively good vision over time.