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Efficacy and safety of oral valganciclovir in cytomegalovirus anterior uveitis with uncontrolled intraocular pressure
  1. Mandy O M Wong1,2,
  2. Amy H Y Yu1,2,
  3. Carmen K M Chan1,2
  1. 1 Hong Kong Eye Hospital, Hong Kong SAR, China
  2. 2 Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
  1. Correspondence to Mandy O M Wong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR, China; mandyom2003{at}yahoo.com.hk

Abstract

Background/aims While cytomegalovirus (CMV) anterior uveitis (AU) patients often require glaucoma surgery, the effectiveness of systemic anti-viral in long-term intraocular pressure (IOP) control is not well established. Our study aims to identify the 2-year efficacy and safety of oral valganciclovir in CMV AU with uncontrolled IOP.

Methods In this retrospective case series, one eye from each of 17 immunocompetent PCR-proven patients with CMV AU who received a single course of oral valganciclovir for 20–148 days for medically uncontrolled IOP during 2008–2018 were identified. They were examined at baseline, week 2, months 1, 2 and 3, then every 3 months up to 2 years after commencement of valganciclovir, or until IOP-lowering procedure.

Results Median baseline IOP and IOP-lowering medication were 27.0 mm Hg (IQR: 22.9–31.0 mm Hg), and 4.0, respectively. IOP was significantly lower than baseline from 2 weeks to 12 months and at 21 and 24 months after starting valganciclovir (p=0.001 to 0.041, Wilcoxon sign-rank test), with 16.9–46.0% median IOP reduction. Seven (41.2%) and six (35.3%) patients had IOP≤21 mm Hg with same, or reduced, topical medications by 12 and 24 months, respectively. Median time to IOP-lowering intervention or second course of valganciclovir was 12.4 months. There was no serious medication-related adverse event. Common side effects included reduced monocyte count (9 patients) and deranged renal function/electrolytes (5 patients). IOP spike and wound leak occurred in 35.5% and 29.4% of patients, respectively, after diagnostic aqueous tap.

Conclusion In CMV AU with uncontrolled IOP, >1/3 of the patients avoided glaucoma surgery over 2 years with a course of oral valganciclovir.

  • Glaucoma
  • Infection
  • Treatment Medical
  • Intraocular pressure
  • Inflammation

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Footnotes

  • Contributors MOMW: conception, design, collecting data, drafting the article, analysis and interpretation of data. AHYY: collecting data, drafting the article. CKMC: design, drafting the article. MOMW, AHYY and CKMC were all involved in revising the article critically for important intellectual content. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

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