Abstract
We evaluated the therapeutic outcome of intravitreal injection (IVI) of ganciclovir with/without oral valganciclovir for cytomegalovirus (CMV) anterior segment infection. We enrolled 61 patients (61 eyes) with PCR-proven CMV anterior segment infection. IVI of ganciclovir (2 mg/0.05 mL) was given as a loading dose; subsequent use of oral valganciclovir (900 mg twice daily) was determined according to the severity of anterior chamber inflammation after injection. All eyes had IVI of ganciclovir, and 53 patients received oral valganciclovir as adjunctive therapy with a mean duration of 1.9 months to achieve disease remission. Repeated diagnostic aqueous taps were performed in 37 eyes with suspected recurrence, and CMV DNA was positive in 24 eyes. This therapeutic strategy afforded a median 50% recurrence-free survival time of 47.0 ± 8.12 months. The patients’ mean best corrected visual acuity, intraocular pressure and corneal endothelial cell counts stabilized or improved. Corneal transplantation before CMV infection diagnosis was identified as an independent risk factor for recurrence (hazard ratio 6.81, 95% confidence interval 1.21–38.23, P = 0.029). In patients with CMV anterior segment infection, the relative short-term therapeutic strategy, IVI of ganciclovir in adjunction with/without oral valganciclovir, effectively achieved a median recurrence-free survival time of nearly 4 years.
Highlights
We evaluated the therapeutic outcome of intravitreal injection (IVI) of ganciclovir with/without oral valganciclovir for cytomegalovirus (CMV) anterior segment infection
CMV infection has been identified in patients diagnosed with idiopathic corneal endotheliitis, Posner-Schlossman syndrome, and Fuchs heterochromic iridocyclitis, all of which were previously considered idiopathic[6,7]
Characteristics Number of patients and diseased eyes, no Age at diagnosis, yearsa Male, no Mean follow up period, monthsa History of glaucoma surgery, no History of corneal transplantation, no History of cataract surgery, no Mean best-corrected visual acuity (BCVA) in the diseased eye at diagnosis, logMARa Mean intraocular pressure (IOP) in the diseased eye at diagnosis, mmHga Mean endothelial cell density (ECD) in the diseased eye at diagnosis, cells/mm2a Mean ECD in the healthy eye at diagnosis, cells/mm2a Corneal endothelial cell loss in the diseased eye at diagnosis treatment strategy for CMV anterior segment infection, we extended our previous study in duration and scale
Summary
We evaluated the therapeutic outcome of intravitreal injection (IVI) of ganciclovir with/without oral valganciclovir for cytomegalovirus (CMV) anterior segment infection. Repeated diagnostic aqueous taps were performed in 37 eyes with suspected recurrence, and CMV DNA was positive in 24 eyes This therapeutic strategy afforded a median 50% recurrence-free survival time of 47.0 ± 8.12 months. In patients with CMV anterior segment infection, the relative short-term therapeutic strategy, IVI of ganciclovir in adjunction with/without oral valganciclovir, effectively achieved a median recurrence-free survival time of nearly 4 years. We reported a case series of six patients with CMV anterior uveitis who received intravitreal injection (IVI) of ganciclovir as a loading dose with or without adjunctive oral valganciclovir, and had satisfactory inflammation control without recurrence in a mean follow-up period of 14.7 months in all p atients[12]. The CMV infection recurrence and its associated risk factors, IOP change, best-corrected visual acuity (BCVA) change, and endothelial cell loss over time were all evaluated
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