Requirement of longer term antiviral therapy in patients with cytomegalovirus anterior uveitis with corneal endothelial cell damage

Figures & data

Figure 1 Slit-lamp microscopic photograph with cytomegalovirus anterior uveitis in Patient 1 showing numerous mutton fat keratic precipitations on the central to inferior corneal endothelium with mild stromal edema and elevation of intraocular pressure.

Notes: The anterior chamber contained 2+ cells according to the Standardization of Uveitis Nomenclature grading system. After antiviral treatment, these keratic precipitations and anterior chamber cells were resolved. Additionally, corneal transparency was restored.

Table 1 Clinical findings for patients with CMV anterior uveitis

Patient	Sex	Age at onset of antiviral treatment (years)	Follow-up time after starting antiviral therapy (months)	Duration of symptoms (years)	Eye	CMV DNA copy number	Coin-shaped lesions	Iris atrophy	Corneal endothelial damage (cells/mm^2)	Glaucoma	Max IOP (mmHg)	Systemic therapy	Topical therapy	Successful termination of systemic therapy
1	M	60	64	19	OD	12,000	+	+	+ (436)	+	30	valGCV	GCV	No
2	M	74	65	Unknown	OD	5,100	+	+	+ (654)	−	34	valGCV	GCV	No
												GCV
3	F	58	33	3	OS	180	+	+	+ (1,392)	+	60	valGCV	GCV	No
4	M	57	18	16	OD	59,000	−	+	− (2,170)	−	30	valGCV	GCV	Yes
5	M	56	17	8	OD	470	+	+	+ (1,291)	+	46	valGCV	GCV	No
6	M	57	12	31	OD	120	+	+	+ (1,129)	−	42	valGCV	GCV	Yes
7	M	44	14	2	OS	3,000	+	+	− (2,801)	−	41	valGCV	GCV	Yes
8	F	77	17	Unknown	OS	62,000	−	−	+ (1,100)	+	43	valGCV	GCV	Yes
9	M	73	15	2	OS	170,000	+	+	+ (1,209)	−	26	valGCV	GCV	Yes
10	M	58	4	2	OD	1,600	+	+	− (2,169)	+	44	valGCV	GCV	No
11	M	87	16	6	OD	210,000	+	+	− (2,557)	+	46	valGCV	GCV	Yes
12	F	60	61	Unknown	OD		+	−	− (2,150)	−	36	valGCV	GCV	Yes
					OS	6,800	+	−	− (2,666)	−	43
13	F	54	36	7	OD	10,000	+	+	+ (550)	+	40	valGCV	GCV	No
					OS		+	+	+ (941)	+	25
14	M	69	2	2	OD	1,600	−	−	− (2,001)	+	43	valGCV	GCV	No
					OS		−	−	− (2,342)	+	44

Abbreviations: CMV, cytomegalovirus; M, male; F, female; IOP, intraocular pressure; Max, maximum; valGCV, valganciclovir; GCV, ganciclovir.

Figure 2 Kaplan–Meier analysis showing the probability of using systemic antiviral therapy in cytomegalovirus anterior uveitis.

Notes: In all 4 patients without corneal endothelial cell damage, systemic antiviral therapy could be terminated within 17 months, whereas 5 of the 8 patients (62.5%) with corneal endothelial damage had to continue systemic therapy to prevent recurrent inflammation or intraocular pressure elevation (P = 0.023, Wilcoxon signed-rank test).