PT  - JOURNAL ARTICLE
AU  - Mandy O M Wong
AU  - Amy H Y Yu
AU  - Carmen K M Chan
TI  - Efficacy and safety of oral valganciclovir in cytomegalovirus anterior uveitis with uncontrolled intraocular pressure
AID  - 10.1136/bjophthalmol-2020-317044
DP  - 2021 Dec 01
TA  - British Journal of Ophthalmology
PG  - 1666--1671
VI  - 105
IP  - 12
4099  - http://bjo.bmj.com/content/105/12/1666.short
4100  - http://bjo.bmj.com/content/105/12/1666.full
SO  - Br J Ophthalmol2021 Dec 01; 105
AB  - 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.