Efficacy and safety of an extemporaneous preparation of 2% ganciclovir eye drops in CMV anterior uveitis

Abstract

BackgroundTo evaluate the efficacy and safety of an extemporaneous preparation of 2% ganciclovir topical eye drops in cytomegalovirus (CMV) anterior uveitis because many studies have confirmed the benefits of topical ganciclovir in varying concentrations.DesignThe study employed a retrospective cohort design.MethodsThis study enrolled 11 eyes (11 patients) with CMV anterior uveitis. All cases were proved by positive PCR for CMV DNA from aqueous tapping and received topical 2% ganciclovir, applied every 2 hours daily as induction therapy then tapered off and stopped based on clinical response. Outcome measures were best-corrected visual acuity, anterior chamber cell, coin-shaped and other keratic precipitates, intraocular pressure (IOP), the number of antiglaucoma drugs used, the frequency of steroid eye drops used daily and side effects over a 12-month follow-up period. Side effects after applying topical 2% ganciclovir were recorded using questionnaires and eye examination.ResultsMean age was 49.0±17.8 years. IOP, number of antiglaucoma drugs used and keratic precipitates decreased significantly at first week (p<0.013, p<0.024 and p<0.031, respectively) followed by decreased anterior chamber cells and significantly reduced frequency of applying steroid eye drops at 4 weeks (p<0.034 and p<0.017, respectively). Visual acuity significantly improved at 5 months continuously. All clinical improvement was maintained to 12 months, and keratic precipitates were eliminated in 90% of all cases. However, in 27% of discontinued medicine cases, inflammation was recurrent. No significance was observed in all factors between recurrent and non-recurrent groups. The most common side effect was eye irritation (27.27%). No severe complications from the medicine was detected.ConclusionExtemporaneous preparation topical 2% ganciclovir was effective and safely controlled CMV anterior uveitis. The medication is non-invasive, economical and convenient for hospitals where commercial topical ganciclovir is unavailable.

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

“…However, systemic ganciclovir has the risk of systemic side effects including granulocytopenia, thrombocytopenia, and anemia. Recently, many studies have confirmed the benefits of topical ganciclovir for CMV-AU treatment [15][16][17][18]. The concentration of the drug was reported to be 0.15% ganciclovir gel and 0.5% to 2% ganciclovir eye drops.…”

“…Continuous topical 0.5% ganciclovir eye drop treatment did not cause systemic or ocular complications. No studies have reported significant side effects, such as ocular discomfort or corneal toxicity, with topical ganciclovir treatment [15,17,18]. Continuous 0.5% ganciclovir eye drop treatment may reduce the rate of recurrence of anterior chamber inflammation and result in the avoidance of glaucoma surgery.…”

An Unusual Cytomegalovirus Ocular Manifestation in a Non-HIV Patient

“…Topical ganciclovir and topical prednisolone are used in treating corneal endotheliitis to target both infectious and inflammatory components. Topical ganciclovir 2% was effective and safe for anterior segment inflammation secondary to CMV infection [ 15 - 17 ]. This preparation is beneficial when commercially prepared topical ganciclovir is not widely available.…”

A double masked randomised 4-week, placebo-controlled study in the USA, Thailand and Taiwan to compare the efficacy of oral valganciclovir and topical 2% ganciclovir in the treatment of cytomegalovirus anterior uveitis: study protocol

“…Non-serious adverse events may include any unfavourable medical occurrences in participants who have ever received study medication, regardless of any causal relationship with treatment. This may include increased intraocular pressure (>24 mm Hg), abnormal laboratory findings (rise in creatinine from ≥1.5 to<2 mg/dL, reduction of white blood cell count to below >1000 to <2500/μL, platelet count from 20 000 to 75 000, or haemoglobin level from >6.5 to <9 g/dL), concurrent accident or illness, increase in the frequency and severity of a pre-existing condition, side effects intolerable to participants (gastrointestinal upset, nausea, vomiting, fatigue), or signs of corneal or conjunctival toxicity (keratitis or conjunctivitis) 23 24 31…”

“…Topical ganciclovir 2% has also been used to treat and prevent recurrences of CMV anterior uveitis 20–22. Topical therapy is attractive as it does not require laboratory monitoring, although ocular side effects including corneal epitheliopathy and conjunctivitis could preclude long-term use 23 24. Thus, comparing oral valganciclovir 900 mg two times per day to topical ganciclovir 2% six times per day has equipoise in the uveitis/cornea specialist.…”