Efficacy and safety of topical ganciclovir in the management of cytomegalovirus (CMV)-related anterior uveitis

Abstract

BackgroundThe aim of this study was to evaluate the efficacy and safety of topical ganciclovir 0.15 % gel in the management of patients with cytomegalovirus (CMV) anterior uveitis.ResultsThis was a retrospective cohort study of the disease course of 31 patients (33 eyes) with aqueous polymerase chain reaction (PCR) positive for CMV. Data from a total of 160 episodes of anterior uveitis flare for 20 years, dating from December 1992 to December 2012, was collected. All patients were treated with concomitant topical anti-inflammatory medication. The disease course of each eye was analysed before and after the use of topical ganciclovir 0.15 %. The mean age at initial presentation of anterior uveitis was 57.5 ± 12.6 years. Twenty-eight (90.3 %) patients were Chinese. Patients on topical ganciclovir gel had a statistically significant fewer episodes of uveitis flare per person year (median −0.88 episodes/person years, p = 0.029). The time-to-quiescence was not significantly affected by topical ganciclovir use (median −1.25 days, p = 0.610). In the survival analysis using the Cox regression model, the use of topical ganciclovir was associated with a lower risk of recurrence, but this was not statistically significant (hazard ratio = 0.857, 95 % CI 0.543–1.36, p = 0.511). The overall median time-to-recurrence was 290 days (95 % CI 113 to 274 days) and 164 days (125 to 404 days) (p = 0.492), with and without topical ganciclovir, respectively.ConclusionsTopical ganciclovir may be beneficial in reducing the frequency of recurrence in patients with CMV anterior uveitis, but it was not statistically associated with prolonging the time-to-recurrence. The time-to-quiescence was also not significantly affected by topical ganciclovir. Prospective studies with a larger number of patients would be required to verify our findings.

Cytomegalovirus-related uncontrolled glaucoma in an immunocompetent patient: a case report and systematic review

“…Most studies recommend a 3-month course of oral anti-viral treatment [ 3 , 5 , 6 , 16 ]. Nevertheless, some studies reported that the relapse rate in patients with CMV were high regardless of treatment regimen [ 6 , 17 ]. It was anticipated that antiviral medicines like ganciclovir are virostatic.…”

Rezidivprophylaxe der Zytomegalievirus-Uveitis mit topischem Ganciclovir

“…Allerdings kam es wiederum bei bis zu 75 % der Patienten nach Therapiestopp zu einem Rezidiv [4,5]. Wurde nach initialer topischer Therapie von 5 Applikationen täglich auf eine Langzeittherapie von 3-4 Applikationen täglich umgestellt, konnte eine Reduktion der Rezidive gezeigt werden [6,7].…”

“…Unsere Ergebnisse decken sich mit den Resultaten anderer Studien. Auch Wong et al fanden eine Reduktion der Schubfrequenz unter topischer Ganciclovir-Therapie in einem mehrheitlich asiatischen Patientenkollektiv unter einer 3-4 × täglichen Applikation [7]. Ebenfalls Antoun et al verwendeten die Therapie langfristig 3-4 × täglich und fanden so eine Abnahme der Schubfrequenz [6].…”

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

“… 15 Local ganciclovir therapy has become more popular for producing fewer systemic side effects including intravitreal ganciclovir 16 and topical ganciclovir. Many studies have confirmed the benefits of topical ganciclovir in varying concentrations from 0.15% ganciclovir 17 18 and 0.5% ganciclovir 16 19 to 2% ganciclovir. 20 21 Commercial topical 0.15% ganciclovir gel is available in many countries; however, in some countries such as Thailand, it has not been imported yet.…”