Cytomegalovirus Anterior Uveitis Research Articles

Long-term Efficacy of Oral Valganciclovir in Presumed Cytomegalovirus Unilateral Hypertensive Anterior Uveitis

ABSTRACT Purpose To describe long-term efficacy and safety of oral valganciclovir in the treatment of presumed cytomegalovirus (CMV) unilateral hypertensive anterior uveitis. Methods Retrospective review of 40 patients (40 eyes). Results All patients presented with high intraocular pressure (mean 39.35 ± 7.58 mmHg), associated with signs of mild anterior uveitis. Oral valganciclovir resulted in control of the intraocular pressures and inflammation in 35 eyes. At the dose of ≥450 mg twice daily, no relapses were documented. The follow-up period ranged from 12 to 108 months (24.45 ± 14.56). At the final follow-up, the intraocular pressure was reduced to 14.92 ± 2.43 mmHg (<0.001). Drug-related complications in the form of leukopenia and azoospermia were reported in one patient. Conclusions Oral valganciclovir effectively and safely controls intraocular pressure and inflammation in presumed CMV anterior uveitis. A long-term treatment course seems necessary.

Zapalenie przedniego odcinka błony naczyniowej spowodowane infekcją cytomegalowirusem u immunokompetentnych pacjentów – diagnostyka i leczenie na przykładzie przypadków klinicznych

Uveitis caused by reactivation of cytomegalovirus appears to be a rare disease that usually affects immunocompromised patients, but a recent review of the literature provides us with more and more examples of its occurrence in immunocompetent individuals as well. With the widespread use of polymerization chain reaction tests from the aqueous fluid, it has been demonstrated that cytomegalovirus may be responsible for most cases of the infectious iritis. The variable clinical course of cytomegalovirus anterior uveitis can make it difficult to provide an appropriate diagnosis. The key is to promptly initiate appropriate treatment and effectively prevent recurrence, as the reis a very high risk of complications, i.e. glaucoma or macular edema. Based on exemplary clinical cases, the different forms of inflammation, diagnosis and treatment are discussed.

IgG-antibodies to individual cytomegalovirus proteins and the peripheral blood lymphocyte subset profile in patients with anterior uveitis of varying severity

Background. Cytomegalovirus (CMV), a human beta-herpesvirus, persists latently lifelong after infection. CMV reactivation that occurs periodically can cause disease in target organs including the eye, not only in immunosuppressed, but also in immunocompetent people. Due to its immunosuppressive properties, persistent CMV is involved in the pathogenesis of diverse diseases. The aim was to study the features of antibody formation against six individual CMV proteins and to conduct a correlation analysis with parameters of peripheral blood lymphocyte profile in patients with anterior uveitis of varying severity (without hypopion-mild course, with hypopion-more severe course). Materials and methods. 36 patients with anterior uveitis were examined. Group I consisted of 20 patients without hypopion, group II 16 people with hypopion. No characteristic features of CMV anterior uveitis (elevated intraocular pressure, stromal iris atrophy) were found. Blood serum anti-CMV IgG antibodies (markers of chronic infection) were measured by ELISA, antibodies against individual recombinant CMV antigens were assessed by Line-Immunoassay specific to the main non-structural immediate early protein (IE), DNA-binding phosphoprotein p52, phosphoproteins of the tegument p150, p65, p28, GB-AD envelope glycoprotein. Lymphocyte subset composition was studied by flow cytometry: T-lymphocytes (CD3+), T-helper cells (CD3+CD4+CD8), T-cytotoxic (CD3+CD4CD8+), T-double-positive (CD3+CD4+CD8+), natural killers (CD16+CD56+), B-lymphocytes (CD19+). Statistical analysis was performed using StatTech v. 3.0.2 program (Stattech LLC, Russia). Results. In mild anterior uveitis, there was observed a significantly increased percentage of CD16+CD56+ and a decreased absolute number of CD3+CD8+ compared with anterior uveitis of a more severe course. Only in the group of patients with hypopion (more severe course) there was a direct significant correlation between level of antibodies against IE, p65, p28 antigens and percentage of double-positive cells (CD3+CD4+CD8+) as well as an negative significant relationship between the level of antibodies against IE, p65 and p52 antigens and CD19+ lymphocytes. Conclusion. The data obtained are consistent with few reports on the role of double-positive lymphocytes in the pathogenesis of severe forms of some viral diseases. Further studies are needed to assess an effect of individual viral antigens on CD3+CD4+CD8+ level in patients with chronic CMV infection to confirm the role of double-positive lymphocytes in the pathogenesis of a more severe course of anterior uveitis.

Overview and update on cytomegalovirus-associated anterior uveitis and glaucoma.

Cytomegalovirus anterior uveitis is the most common ocular inflammatory disease caused by cytomegalovirus infection. It mainly occurs in middle-aged males with competent immunologic function, and the incidence is higher in Asia. The clinical manifestations vary from Posner-Schlossman syndrome and corneal endotheliitis to Fuchs uveitis syndrome, and are often accompanied by intraocular hypertension. Secondary glaucoma is a potentially blinding ocular complication with a pathogenesis that includes complicated immunological factors, intraocular inflammation, different types of angle abnormalities, and the administration of steroids, which may result in physical discomfort and visual impairment. Diagnostic tests, such as the polymerase chain reaction, optical coherence tomography, ocular microscopy, and confocal microscopy, might help in identifying anterior uveitis caused by other viruses. Combinations of antiviral medications and anti-inflammatory agents are effective treatments. If pharmacological therapy cannot reduce intraocular pressure or slow the progression of glaucomatous optic neuropathy, surgical intervention is required as a last resort.

Cytomegalovirus Anterior Uveitis in an Immunocompetent Patient

Abstract Most cases of uveitis involve the anterior compartment with resultant iritis, cyclitis, or iridocyclitis. Usually, they are either associated with an autoimmune condition or relegated as idiopathic. Approximately 10% of the time an infectious disease etiology is determined to be the cause, in which case, herpes simplex virus and less often varicella zoster virus are the pathogens. Traditionally, cytomegalovirus ocular infections present with retinitis or acute retinal necrosis and almost always in immunocompromised hosts (eg, AIDS), We present a case of chronic cytomegalovirus anterior uveitis in an immunocompetent man diagnosed only after failing the treatment of presumed herpes simplex virus infection and the epidemiology, proposed mechanism of infection, clinical manifestations, diagnostic tests, and treatment of this less well-recognized infection in patients with adequate immune systems.

Cytomegalovirus Anterior Uveitis: Clinical Manifestations, Diagnosis, Treatment, and Immunological Mechanisms.

Little is known regarding anterior uveitis (AU), the most common ocular disease associated with cytomegalovirus (CMV) infection in immunocompetent populations. CMV AU is highly prevalent in Asia, with a higher incidence in men. Clinically, it manifests mainly as anterior chamber inflammation and elevated intraocular pressure (IOP). Acute CMV AU may resemble Posner-Schlossman syndrome with its recurrent hypertensive iritis, while chronic CMV AU may resemble Fuchs uveitis because of its elevated IOP. Without prompt treatment, it may progress to glaucoma; therefore, early diagnosis is critical to prognosis. Knowledge regarding clinical features and aqueous humor analyses can facilitate accurate diagnoses; so, we compared and summarized these aspects. Early antiviral treatment reduces the risk of a glaucoma surgery requirement, and therapeutic effects vary based on drug delivery. Both oral valganciclovir and topical ganciclovir can produce positive clinical outcomes, and higher concentration and frequency are beneficial in chronic CMV retinitis. An extended antiviral course could prevent relapses, but should be limited to 6 months to prevent drug resistance and side effects. In this review, we have systematically summarized the pathogenesis, clinical features, diagnostic and therapeutic aspects, and immunological mechanisms of CMV AU with the goal of providing a theoretical foundation for early clinical diagnosis and treatment.

Outcomes and prognostic factors of cataract surgery in cytomegalovirus-related anterior uveitis.

To evaluate the outcomes of cataract surgery in patients with cytomegalovirus (CMV) anterior uveitis and factors associated with final visual outcome. Hong Kong Eye Hospital, Hong Kong. Retrospective case series. History, clinical characteristics, corrected distance visual acuity (CDVA), medications, and complications of CMV anterior uveitic eyes that underwent cataract surgery between 2010 and 2020 were reviewed. This study included 26 eyes of 26 patients undergoing phacoemulsification. The median duration of disease was 4.8 years, and the median quiescent period preoperatively was 2.3 years. None required pupil manipulation or had significant intraoperative complications. The median CDVA improved from 20/100 (interquartile range [IQR] 20/200 to 20/50) preoperatively to 20/30 (IQR 20/40 to 20/25) at 1 year and 20/35 (IQR 20/50 to 20/30) at the last follow-up at a median of 4.9 years postoperatively ( P < .001). CDVA improved in 19 eyes (73.1%) and was ≥20/40 in 18 eyes (69.2%). In the multivariate regression model, preoperative use of topical 0.15% ganciclovir (β = 0.33, 95% CI 0.17 to 0.48, P < .001) and adjunctive intraoperative intracameral dexamethasone 0.4 mg (β = 0.19, 95% CI 0.01 to 0.36, P = .043) were associated with a better final CDVA. Loss of CDVA and poor postoperative CDVA visual acuity were mostly attributed to uveitic glaucoma, but preoperative glaucoma or the number of antiglaucoma medications did not affect final CDVA. Cataract surgery in eyes with CMV anterior uveitis was safe and CDVA significantly improved and remained sustained postoperatively. Topical ganciclovir 0.15% preoperatively and intracameral corticosteroid intraoperatively seem to maximize the final visual outcome.

Two Year Outcomes of Trabeculectomy in Cytomegalovirus Anterior Uveitis with Uncontrolled Intraocular Pressure

ABSTRACT Purpose To describe the two-year outcome of trabeculectomy in cytomegalovirus(CMV) anterior uveitis(AU). Methods Records of 29 eyes of 29 consecutive CMV AU patients undergoing MMC-augmented trabeculectomy for uncontrolled IOP despite maximal tolerated topical medications were retrospectively reviewed. Treatment success was defined as IOP≤21 mmHg with same or reduced number of IOP-lowering medications compared to baseline, without systemic acetazolamide or further interventions for uncontrolled IOP. Results Treatment success was 79.3% (23/29) at 24 months. Both median IOP and number of IOP-lowering medications dropped significantly from baseline (p < .01 and p < .001, all time-points, Wilcoxon sign-rank test, respectively), with 63.2% and 19.0% reduction in AU relapse/year and steroid use(p = .001 and 0.03, respectively), without sight-threatening sequelae. At 24 months, AU frequency was not significantly different between successful cases with and without ≥12-month use of topical ganciclovir (p = .51, Mann-Whitney U test). Conclusion MMC-augmented trabeculectomy was efficacious for IOP control in nearly 80% of CMV AU cases over two years.

Iridian anterior segment OCT in rubella uveitis syndrome and cytomegalovirus anterior uveitis: a comparative study.

To compare iris affectation in cytomegalovirus anterior uveitis (CMVAU), rubella virus-associated uveitis (RVU), and healthy contralateral eyes, using swept-source anterior segment optical coherence tomography (SS-AS-OCT). A comparative, transversal, retrospective study examining 60 eyes from 30 patients-18 eyes (17 patients) with CMVAU, 14 eyes (13 patients) with RVU, and 28 healthy eyes-was performed. Six-millimeter cross-sectional SS-AS-OCT B-scans were obtained in each iris quadrant. Images were exported to ImageJ®. Qualitative and quantitative analyses were done: stromal thickness (ST), smooth index (SI), and optical density (OD) of pigment epithelium. Comparisons between measurements and clinical-demographic parameters were performed using SPSS®. Qualitative analysis showed extensive damage in iris stroma but was unable to differentiate between both uveitis. RVU eyes had a lower mean ST (315.72μm ± 42.4) compared to those with CMVAU (348.6μm ± 46) (p = 0.047) and a lower ST in the upper (338.9μm ± 38.52)/(386.25μm ± 47.2) (p = 0.005) and temporal (281.5μm ± 57.3)/(326.43μm ± 62.3) (p = 0.016) quadrants. Mean (0.94 ± 0.02)/(0.9 ± 0.03) (p = 0.001), temporal (0.94 ± 0.02)/(0.89 ± 0.03) (p < 0.001), and nasal SI (0.094 ± 0.02)/(0.9 ± 0.04) (p = 0.005) were higher in RVU. OD was similar in both uveitis. In healthy eyes, mean ST (376.8μm ± 39.7) was higher and mean SI was lower (0.87 ± 0.04) than in RVU (p < 0.001) and CMVAU eyes (p = 0.032). Mean OD was higher in healthy eyes (911 ± 130) than in CMVAU eyes (800 ± 200) (p = 0.037). The quantitative analysis of the SS-AS-OCT iris images allows for the differentiation between healthy eyes and those with CMVAU and RVU, as well as between both uveitis.

Long-Term Outcome of Treatment with 2% Topical Ganciclovir Solution in Cytomegalovirus Anterior Uveitis and Corneal Endotheliitis.

PurposeThis study aimed to evaluate the therapeutic efficacy and long-term outcomes of treatment with topical 2% ganciclovir solution in immunocompetent patients with aqueous humor polymerase chain reaction (PCR)-proven cytomegalovirus (CMV) anterior uveitis and corneal endotheliitis.MethodsWe retrospectively reviewed the findings for immunocompetent patients diagnosed with CMV uveitis or endotheliitis based on clinical manifestations and polymerase chain reaction (PCR) examination results and treated with topical 2% ganciclovir solution at National Cheng Kung University Hospital. Clinical outcome measurements included evaluations of the response rate, relapses, resolution of anterior chamber inflammation, visual acuity, and intraocular pressure.ResultsThe study included 38 eyes of 32 patients. Long-term administration of topical 2% ganciclovir significantly decreased keratic precipitates (p = 0.001), anterior chamber cells (p = 0.001), and reduced intraocular pressure (p < 0.001). Only one eye was unresponsive to topical ganciclovir treatment, and the recurrence decreased to 0.13 relapses per year. The presence of keratic precipitates and higher intraocular pressure at the initial presentation were significantly associated with recurrence (p = 0.036 and p = 0.001, respectively).ConclusionsLong-term use of topical 2% ganciclovir solution is effective, safe, and applicable when commercialized ganciclovir gel is not available.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Dean M. CestariDean M. CestariDr Cestari completed residencies in both Neurology and Ophthalmology at the Cornell University Medical College's New York Presbyterian Hospital, as well as fellowship training in neuro-ophthalmology at the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Massachusetts, USA. He is one of approximately 10 physicians in the United States who is board certified by both the American Board of Ophthalmology and the American Board of Psychiatry & Neurology. Dr Cestari joined the full-time faculty of Mass. Eye and Ear, a primary teaching hospital for Harvard Medical School, in 2006 and currently holds the rank of Associate Professor of Ophthalmology, Harvard Medical School. He is very involved in medical education and is the Director of the Clinical Fellowship program at The Massachusetts Eye and Ear Infirmary. His efforts as a clinician-scientist focus on the evaluation and treatment of patients who present with neuro-ophthalmic disease. He is also very involved in the medical and surgical treatment of thyroid eye disease with strabismus and diplopia. He just published a surgical textbook entitled, “Learning Strabismus Surgery, A Case Based Approach.” He supervises clinical fellows, second year residents and visiting medical students and performs adult strabismus surgery and mentors second year residents in the operating theater. Dr Cestari's translational research is focused on developing a rodent model for ischemic optic neuropathy and central retinal artery occlusion. Once this is accomplished, his team will begin to evaluate the safety and efficacy of various novel neuro-protective agents that can be used to preserve and restore vision affected by vascular occlusion. Additionally, he is working with a team of engineers from MIT and Harvard University to design and build an implantable device to restore ocular motility to denervated extra-ocular muscles from nerve palsys. John A. GonzalesJohn A. GonzalesDr Gonzales is an Associate Professor of Ophthalmology at the Francis I. Proctor Foundation at the University of California, San Francisco, USA specializing in uveitis and medical cornea. He is supported by an early career award from the National Institutes of Health – National Eye Institute to study the spectrum of keratoconjunctivitis sicca in Sjögren's syndrome utilizing the Sjögren's International Collaborative Clinical Alliance (SICCA) cohort. Dr Gonzales is also pursuing treatment strategies in cytomegalovirus anterior uveitis in immunocompetent individuals. Dr Gonzales's interests also extend to ocular oncology, specifically primary vitreoretinal lymphoma, and he is interested in how clinical features may be correlated with mutations associated with lymphoproliferation as well as resistance to chemotherapeutics. Dr Gonzales is a Section Editor for Current Opinion in Ophthalmology and is the uveitis fellowship program director at the Proctor Foundation.

Classification Criteria for Cytomegalovirus Anterior Uveitis

To determine classification criteria for cytomegalovirus (CMV) anterior uveitis. Machine learning of cases with CMV anterior uveitis and 8 other anterior uveitides. Cases of anterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the anterior uveitides. The resulting criteria were evaluated on the validation set. One thousand eighty-three cases of anterior uveitides, including 89 cases of CMV anterior uveitis, were evaluated by machine learning. The overall accuracy for anterior uveitides was 97.5% in the training set and 96.7% in the validation set (95% confidence interval 92.4, 98.6). Key criteria for CMV anterior uveitis included unilateral anterior uveitis with a positive aqueous humor polymerase chain reaction assay for CMV. No clinical features reliably diagnosed CMV anterior uveitis. The misclassification rates for CMV anterior uveitis were 1.3% in the training set and 0% in the validation set. The criteria for CMV anterior uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Cytomegalovirus Anterior Uveitis from the Perspective of the Common Practitioner: Missed Diagnosis Can Be at the Origin of Severe Functional Loss - A Scenario to Be Avoided.

Cytomegalovirus Anterior Uveitis from the Perspective of the Common Practitioner: Missed Diagnosis Can Be at the Origin of Severe Functional Loss - A Scenario to Be Avoided.

Aetiology and clinical characteristics of uveitic glaucoma in Turkish patients.

To investigate the types, frequency and clinical profiles of uveitic glaucoma seen at a tertiary care center and also to have an idea about the distribution of uveitic glaucoma types in Turkish population. Consecutive case notes of all patients attending a specialized uveitis clinic over a 3-month period were reviewed retrospectively. One hundred and seven eyes of 96 patients were included. Sixty-five of the eyes had anterior, one intermediate, nine posterior uveitis while 32 of them had panuveitis. Twenty-three eyes had acute, 52 chronic and 32 recurrent uveitis. Herpes virus associated iridocyclitis was the leading cause of anterior uveitis-associated uveitic glaucoma followed by cytomegalovirus (CMV) associated anterior uveitis; while steroid-induced glaucoma accounted for the majority of chronic uveitis with glaucoma followed by Fuchs' uveitis syndrome (FUS). The most common causes of glaucoma among the cases were steroid-induced in 30 eyes (28%), Herpes virus anterior uveitis in 24 eyes (22%), CMV anterior uveitis in 20 eyes (18%), FUS in 15 eyes (14%), ocular toxoplasmosis in 5 eyes (4%). Behçet's uveitis was the most common (n = 11, 36%) cause of steroid-induced glaucoma. The need for surgical intervention was 23.32% (n = 25; 12 of them were FUS, 8 steroid-dependent, 1 HSV and 3 CMV anterior uveitis and 1 angle closure glaucoma with idiopathic uveitis) in our cases. Uveitic glaucoma is a common complication in a tertiary clinic. The most common causes are steroid-induced, FUS, viral anterior uveitis. The most common disease causing steroid induced glaucoma was Behçet's disease. Glaucoma surgery is required in a significant number of cases.

Effect of Continuous 0.5% Ganciclovir Eye Drop Treatment in Secondary Glaucoma Associated with Cytomegalovirus Anterior Uveitis

Purpose: The purpose of this study was to investigate the treatment outcomes of secondary glaucoma caused by cytomegalovirus (CMV)-anterior uveitis (AU) with continuous 0.5% ganciclovir eye drop.&#x0D; Study Design: Retrospective observational study.&#x0D; Place and Duration of Study: Department of Ophthalmology, Oita University Hospital, between January 2012 and December 2017.&#x0D; Methodology: Nineteen eyes of 19 patients with secondary glaucoma associated with CMV-AU diagnosed by a polymerase chain reaction analysis from human aqueous samples were enrolled. They were treated with continuous 4-times-daily topical 0.5% ganciclovir in addition to topical steroids and anti-glaucoma medications. We performed glaucoma surgery for patients with poorly medically controlled intraocular pressure (IOP).&#x0D; Results: Anterior chamber inflammation and IOP were controlled without systemic ganciclovir or glaucoma surgery during the follow-up period (mean: 59.2±27.0 months) in 9 (47%) eyes. Five (26%) eyes required systemic ganciclovir and ten (53%) eyes required glaucoma surgery. Patients were divided into two groups for the comparison: one group requiring glaucoma surgery and one treated with medication. The mean IOP and number of anti-glaucoma medications at the first visit were significantly higher in the surgery group than in the medication group. The mean number of IOP spikes per year (IOP &gt;30 mmHg) was 1.4±0.9 in the surgery group and 0.4±0.5 in the medication group. The recurrence of anterior chamber inflammation was suppressed in both groups. The cumulative survival rate after glaucoma surgery was 80% at 12 months and 70% at 36 months.&#x0D; Conclusion: The anterior chamber inflammation and IOP were controlled with continuous 0.5% ganciclovir eye drop treatment in half of the patients with CNV-AU. A high IOP at the first visit and frequent IOP spikes were risk factors for additional glaucoma surgeries.Cytomegalovirus

Peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer changes on optical coherence tomography in patients with unilateral hypertensive cytomegalovirus anterior uveitis.

To investigate whether peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning are present in patients with unilateral hypertensive Cytomegalovirus anterior uveitis (hCMV AU). We included 19 eyes with unilateral hCMV AU and their unaffected fellow eyes as the control group in this study. Peripapillary RNFL and macular GCIPL changes were determined using spectral-domain (SD) - optical coherence tomography (OCT). The overall calculated mean pRNFL thickness was significantly lower in the effected eyes with hCMV AU than in the uneffected fellow eyes (p = 0.012). The mean macular GCIPL thickness in the affected eyes was also significantly lower than in the normal eyes (p < 0.001). Measurement of pRNFL and macular GCIPL thickness with OCT may detect signs of damage before the visual field changes in patients with hypertensive CMV AU. Early aggressive treatment in these patients may prevent further glaucomatous damage.

Evaluation of Infectious Uveitis at a Tertiary Referral Center in Turkey: A 31-year Retrospective Study.

Objectives:The aim of this study was to examine the demographic and clinical characteristics of patients with infectious uveitis over time.Methods:The records of a total of 2032 patients treated for uveitis were retrospectively analyzed and 369 eyes of 324 patients diagnosed with infectious uveitis were included in the study. The patients were divided into 2 groups according to the date of presentation. The first group comprised patients seen between January 1988 and August 2009, and patients who presented between September 2009 and April 2019 were classified in the second group.Results:The prevalence of infectious uveitis was 15.1% in the first group and 16.8% in the second group. A statistically significant decrease was observed in the number of toxoplasmosis patients in the second group (p=0.031). There was no significant difference in the number of patients with herpetic anterior uveitis (HAU) (p=0.215). A significant increase was recorded in the number of patients with tuberculosis and acute retinal necrosis (ARN) (p=0.006 and p=0.041, respectively). While there were no patients diagnosed with cytomegalovirus (CMV) anterior uveitis in the first group, 19 patients were diagnosed with the disorder in the second group. There was a decrease in the rate of legal blindness among the patients who were treated in the second period compared with the first period; however, this difference was not statistically significant (p=0.069).Conclusion:Toxoplasmosis and HAU were the 2 most common causes of infectious uveitis. The incidence of CMV anterior uveitis, tuberculosis-related uveitis, and ARN increased over the period studied.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Dean M. CestariDean M. CestariDr Cestari completed residencies in both Neurology and Ophthalmology at the Cornell University Medical College's New York Presbyterian Hospital, as well as fellowship training in neuro-ophthalmology at the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Massachusetts, USA. He is one of approximately 10 physicians in the United States who is board certified by both the American Board of Ophthalmology and the American Board of Psychiatry & Neurology. Dr Cestari joined the full-time faculty of Mass. Eye and Ear, a primary teaching hospital for Harvard Medical School, in 2006 and currently holds the rank of Associate Professor of Ophthalmology, Harvard Medical School. He is very involved in medical education and is the Director of the Clinical Fellowship program at The Massachusetts Eye and Ear Infirmary. His efforts as a clinician-scientist focus on the evaluation and treatment of patients who present with neuro-ophthalmic disease. He is also very involved in the medical and surgical treatment of thyroid eye disease with strabismus and diplopia. He just published a surgical textbook entitled, “Learning Strabismus Surgery, A Case Based Approach.” He supervises clinical fellows, second year residents and visiting medical students and performs adult strabismus surgery and mentors second year residents in the operating theater. Dr Cestari's translational research is focused on developing a rodent model for ischemic optic neuropathy and central retinal artery occlusion. Once this is accomplished, his team will begin to evaluate the safety and efficacy of various novel neuro-protective agents that can be used to preserve and restore vision affected by vascular occlusion. Additionally, he is working with a team of engineers from MIT and Harvard University to design and build an implantable device to restore ocular motility to denervated extra-ocular muscles from nerve palsys. John A. GonzalesJohn A. GonzalesDr Gonzales is an Associate Professor of Ophthalmology at the Francis I. Proctor Foundation at the University of California, San Francisco, USA specializing in uveitis and medical cornea. He is supported by an early career award from the National Institutes of Health – National Eye Institute to study the spectrum of keratoconjunctivitis sicca in Sjögren's syndrome utilizing the Sjögren's International Collaborative Clinical Alliance (SICCA) cohort. Dr Gonzales is also pursuing treatment strategies in cytomegalovirus anterior uveitis in immunocompetent individuals. Dr Gonzales's interests also extend to ocular oncology, specifically primary vitreoretinal lymphoma, and he is interested in how clinical features may be correlated with mutations associated with lymphoproliferation as well as resistance to chemotherapeutics. Dr Gonzales is a Section Editor for Current Opinion in Ophthalmology and is the uveitis fellowship program director at the Proctor Foundation.

Efficacy and safety of oral valganciclovir in cytomegalovirus anterior uveitis with uncontrolled intraocular pressure

Background/aimsWhile cytomegalovirus (CMV) anterior uveitis (AU) patients often require glaucoma surgery, the effectiveness of systemic anti-viral in long-term intraocular pressure (IOP) control is not well established. Our study aims to...

Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir.

Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America. This is a retrospective case series review (2002-2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed. Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: -0.21 LogMAR, 95% CI -0.33 to -0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02-0.41; P = 0.002), and IOP (difference: -4.21 mm Hg, 95% CI -7.98 to -0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping. Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.