Long-term results of oral valganciclovir for treatment of anterior segment inflammation secondary to cytomegalovirus infection

Abstract

Background: The purpose of this study was to assess the efficacy of oral valganciclovir in the treatment of anterior segment inflammation caused by cytomegalovirus (CMV) infection.

Methods: Consecutive patients with anterior segment inflammation due to CMV causing anterior uveitis or corneal endotheliitis treated with oral valganciclovir were reviewed. Diagnosis of CMV infection was confirmed by polymerase chain reaction of the aqueous aspirate prior to commencement of oral valganciclovir. All patients were treated with an oral loading dose of 900 mg valganciclovir twice daily for at least 2 weeks, followed by an additional 450 mg valganciclovir twice-daily maintenance therapy. Changes in visual acuity, intraocular pressure (IOP), use of antiglaucomatous eye drops, and recurrence were analyzed.

Results: Thirteen eyes of 11 patients were followed for a mean of 17.2 months. Two patients had bilateral corneal endotheliitis. All eyes had absence of anterior segment inflammation within 3 weeks after treatment. Following treatment, the mean logMAR visual acuity improved significantly from 0.58 at baseline to 0.37 at the last follow-up (P = 0.048). The mean IOP and number of antiglaucomatous eye drops also decreased significantly (P = 0.021 and P = 0.004, respectively). Five (38.5%) eyes had recurrence of anterior uveitis after valganciclovir was stopped and required retreatment with oral valganciclovir.

Conclusion: Oral valganciclovir appeared to be effective in controlling CMV anterior uveitis, resulting in visual improvement and IOP reduction following control of inflammation. However, despite the initial clinical response in all cases, recurrence after cessation of oral valganciclovir could occur.

Keywords: anterior uveitis; antiviral; cytomegalovirus infection; endotheliitis; inflammation; ocular hypertension; valganciclovir.

Figure 1

Slit-lamp photos of the left eye of a patient with anterior segment inflammation from cytomegalovirus. (A) Prior to commencement of valganciclovir, there were diffuse multiple pigmented keratic precipitates on the cornea. (B) Four weeks after valganciclovir therapy, the keratic precipitates completed resolved with absence of inflammation in the anterior chamber. (C) One month after stopping valganciclovir therapy, the was recurrence of keratic precipitates on the cornea with mild anterior chamber inflammation. (D) Two weeks after recommencing valganciclovir, the keratic precipitates again resolved with no inflammation in the anterior chamber.