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

Abstract

Background: To 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.

Design: The study employed a retrospective cohort design.

Methods: This 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.

Results: Mean 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.

Conclusion: Extemporaneous 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.

Keywords: anterior uveitis; cytomegalovirus; glaucoma; topical ganciclovir.

Figure 1

Case 1 had recurrent symptoms at the 3rd month then we stopped using topical 2% ganciclovir at 11th month. IOP, intraocular pressure; VA, visual acuity.

Figure 2

Case 2 had recurrent symptoms at the 7th and 11th months while tapering 2% topical ganciclovir. IOP, intraocular pressure; VA, visual acuity.

Figure 3

Case 3 could be stopped using 2% topical ganciclovir at 3rd month without any recurrent symptoms. IOP, intraocular pressure; VA, visual acuity.

Figure 4

Case 4 (corneal decompensate) still continues topical ganciclovir four times a day for undergoing penetrating keratoplasty  in the future. IOP, intraocular pressure; VA, visual acuity.

Figure 5

Case 5 had recurrent symptoms at fifth month and then finally the patient stopped taking medicine. IOP, intraocular pressure; VA, visual acuity.

Figure 6

Case 6 stopped taking 2% topical ganciclovir at 7th month. After that the recurrent symptoms occurred at 10th month by the presenting of keratic precipitates. IOP, intraocular pressure; VA, visual acuity.

Figure 7

Case 7 stopped taking topical 2% ganciclovir at 6th month then recurrent symptoms occurred at 9th month. IOP, intraocular pressure. VA, visual acuity.

Figure 8

Case 8 had no recurrence; however he was still on medicine. At 10th month follow-up, the patient had poor compliance to take antiglaucoma medicine. IOP, intraocular pressure; VA, visual acuity.

Figure 9

Case 9 could be stopped using 2% topical ganciclovir at 11th month without any recurrent symptoms. IOP, intraocular pressure; VA, visual acuity.

Figure 10

Case 10 could be stopped using 2% topical ganciclovir at 11th month without any recurrent symptoms. IOP, intraocular pressure; VA, visual acuity.

Figure 11

Case 11 stopped taking medicine by herself at 2 weeks then the recurrent symptoms occurred at 5th month. After that topical 2% ganciclovir was restarted. IOP, intraocular pressure; VA, visual acuity.