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

doi:10.1186/s12348-016-0078-z

. 2016 Dec;6(1):10.

doi: 10.1186/s12348-016-0078-z. Epub 2016 Mar 15.

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

John X H Wong¹, Rupesh Agrawal², Elizabeth P Y Wong², Stephen C Teoh^{2

3}

Affiliations

¹ National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore. john_wong@ttsh.com.sg.
² National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
³ Eagle Eye Centre, Singapore, Singapore.

PMID: 26976016
PMCID: PMC4791412
DOI: 10.1186/s12348-016-0078-z

Free PMC article

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

John X H Wong et al. J Ophthalmic Inflamm Infect. 2016 Dec.

Free PMC article

. 2016 Dec;6(1):10.

doi: 10.1186/s12348-016-0078-z. Epub 2016 Mar 15.

Authors

John X H Wong¹, Rupesh Agrawal², Elizabeth P Y Wong², Stephen C Teoh^{2

3}

Affiliations

¹ National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore. john_wong@ttsh.com.sg.
² National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
³ Eagle Eye Centre, Singapore, Singapore.

PMID: 26976016
PMCID: PMC4791412
DOI: 10.1186/s12348-016-0078-z

Abstract

Background: The 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.

Results: This 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.

Conclusions: Topical 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.

Keywords: CMV anterior uveitis; Recurrence of anterior uveitis; Topical ganciclovir.

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Figures

**Fig. 1**
Kaplan-Meier survival estimates with and without topical ganciclovir

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References

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1. Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiaidis G. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology. 2002;109:879–882. doi: 10.1016/S0161-6420(02)00961-2. - DOI - PubMed
1. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145(5):834–40. doi: 10.1016/j.ajo.2007.12.015. - DOI - PubMed
1. Davies ME, Bondi JV, Grabowski L, Schofield TL, Field AK. 2′-nor-2′deoxyguanosine is an effective therapeutic agent for treatment of experimental herpes keratitis. Antiviral Res. 1987;7(2):119–125. doi: 10.1016/0166-3542(87)90027-1. - DOI - PubMed

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[1] Bloch-Michel E, Dussaix E, Cerqueti P, Patarin D. Possible role of cytomegalovirus infection in the etiology of the Posner-Schlossmann syndrome. Int Ophthalmol. 1987;11:95–96. doi: 10.1007/BF00136737. - DOI - PubMed

[2] Bloch-Michel E, Dussaix E, Cerqueti P, Patarin D. Possible role of cytomegalovirus infection in the etiology of the Posner-Schlossmann syndrome. Int Ophthalmol. 1987;11:95–96. doi: 10.1007/BF00136737. - DOI - PubMed

[3] Teoh SB, Thean L, Koay E. Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye. 2005;19:1338–1340. doi: 10.1038/sj.eye.6701757. - DOI - PubMed

[4] Teoh SB, Thean L, Koay E. Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye. 2005;19:1338–1340. doi: 10.1038/sj.eye.6701757. - DOI - PubMed

[5] Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiaidis G. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology. 2002;109:879–882. doi: 10.1016/S0161-6420(02)00961-2. - DOI - PubMed

[6] Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiaidis G. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology. 2002;109:879–882. doi: 10.1016/S0161-6420(02)00961-2. - DOI - PubMed

[7] Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145(5):834–40. doi: 10.1016/j.ajo.2007.12.015. - DOI - PubMed

[8] Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145(5):834–40. doi: 10.1016/j.ajo.2007.12.015. - DOI - PubMed

[9] Davies ME, Bondi JV, Grabowski L, Schofield TL, Field AK. 2′-nor-2′deoxyguanosine is an effective therapeutic agent for treatment of experimental herpes keratitis. Antiviral Res. 1987;7(2):119–125. doi: 10.1016/0166-3542(87)90027-1. - DOI - PubMed

[10] Davies ME, Bondi JV, Grabowski L, Schofield TL, Field AK. 2′-nor-2′deoxyguanosine is an effective therapeutic agent for treatment of experimental herpes keratitis. Antiviral Res. 1987;7(2):119–125. doi: 10.1016/0166-3542(87)90027-1. - DOI - PubMed

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

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

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