valganciclovir and Uveitis--Anterior

Cytomegalovirus (CMV) anterior uveitis is a recognised cause of anterior uveitis in immunocompetent patients and is preventable cause of vision loss. Ocular sequelae include corneal endothelial damage which can cause corneal oedema and failure, as well as glaucoma. Recurrences of inflammation are common and therefore patients are often exposed to long-term therapy. Oral therapy is available in the form of valganciclovir, although with the caveat of systemic side effects such as bone marrow suppression and renal failure necessitating regular interval laboratory monitoring. Recent reports have demonstrated that topical 2% ganciclovir solution may offer promising treatment outcomes in patients with CMV anterior uveitis with superior safety, cost-effectiveness and convenience profiles. An investigation into the relative equipoise of these therapies is warranted for these reasons.. The Systemic and Topical Control of Cytomegalovirus Anterior uveitis: Treatment Outcomes (STACCATO) trial is designed as a multicentre, block randomised by site, double-masked, placebo-controlled trial comparing the efficacy of oral valganciclovir, 2% topical ganciclovir and placebo in treating PCR-proven CMV anterior uveitis. Participant clinical evaluation will occur at three study time points by a masked study ophthalmologist over a 28-day period to assess resolution of ocular inflammation (secondary outcome). A control group will provide additional information about the possible impact that the infected host's immune response may play in controlling local viral replication. The primary analysis is an analysis of covariance (three arms) correcting for baseline to compare quantitative CMV viral load in the anterior chamber (AC) aqueous fluid before and 7 days after treatment.. The University of California San Francisco Committee on Human Research and the Khon Kaen University Institutional Review Board have given ethical approval. The results of this trial will be presented at local and international meetings and submitted for peer-reviewed journals for publication.. NCT03576898.

Topics: Administration, Oral; Administration, Topical; Antiviral Agents; Cytomegalovirus Infections; Double-Blind Method; Ganciclovir; Humans; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Taiwan; Thailand; United States; Uveitis, Anterior; Valganciclovir; Viral Load

A pilot study was conducted to evaluate the therapeutic results of intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir for the treatment of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients.. Six consecutive patients in whom active CMV anterior uveitis was detected by polymerase chain reaction assay of the aqueous humor were enrolled between January 2006 and December 2008. These patients received an intravitreal injection of ganciclovir (2 mg/0.05 ml) as a loading dose. Subsequent use of oral valganciclovir (900 mg twice a day) was determined according to the severity of the post-injection aqueous inflammation. Immune status and anterior chamber reaction of individual patients, visual acuity, intraocular pressure (IOP) at study entry, and follow-up intervals were examined.. The mean patient-month follow-up period after intravitreal injection was 14.7 months (range, 12-22 months). Two patients received only the intravitreal ganciclovir injection once and four patients had received the following oral valganciclovir for average 2.3 months (range, 1-4 months). With this treatment strategy, the best-corrected visual acuity of the patients improved or stabilized; the IOP and the inflammation of anterior chamber of the patients were well controlled at all time points and there were no treatment-associated complications by the end of follow-up.. In patients with CMV anterior uveitis, intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir can control the inflammation and IOP well.

Topics: Administration, Oral; Adult; Aged; Antiviral Agents; Cytomegalovirus Infections; Female; Follow-Up Studies; Ganciclovir; Humans; Immunocompetence; Injections, Intraocular; Male; Middle Aged; Pilot Projects; Treatment Outcome; Uveitis, Anterior; Valganciclovir; Visual Acuity; Vitreous Body

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

Topics: Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Glaucoma; Humans; Intraocular Pressure; Retrospective Studies; Treatment Outcome; Uveitis, Anterior; Valganciclovir

Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America.. This is a retrospective case series review (2002-2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed.. Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: -0.21 LogMAR, 95% CI -0.33 to -0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02-0.41; P = 0.002), and IOP (difference: -4.21 mm Hg, 95% CI -7.98 to -0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping.. Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.

Topics: Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Aqueous Humor; Cytomegalovirus; Cytomegalovirus Infections; Eye Infections, Viral; Female; Humans; Male; Middle Aged; North America; Retrospective Studies; Tertiary Care Centers; Uveitis, Anterior; Valganciclovir; Visual Acuity; Young Adult

Cytomegalovirus (CMV) anterior uveitis and endotheliitis occurs among immunocompetent individuals and may manifest as Posner-Schlossman syndrome or Fuchs uveitis syndrome. The condition may first present following ophthalmic surgery, the use of a fluocinolone-sustained steroid drug delivery implant, or the use of topical prostaglandin analogues for the treatment of glaucoma. We report the first case of a non-human immunodeficiency virus-infected individual who presented with CMV anterior uveitis after the use of topical cyclosporine A 0.05% ophthalmic emulsion for the treatment of symptomatic dry eyes.

Topics: Administration, Ophthalmic; Aged; Antiviral Agents; Aqueous Humor; Cyclosporine; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Dry Eye Syndromes; Emulsions; Eye Infections, Viral; Female; Ganciclovir; Gene Dosage; Humans; Immunosuppressive Agents; Real-Time Polymerase Chain Reaction; Uveitis, Anterior; Valganciclovir

To report the characteristics of cytomegalovirus anterior uveitis (CMV AU) and the comparative response to 2 types of antiviral induction treatments.. Retrospective, consecutive case series.. Consecutive immunocompetent patients with polymerase chain reaction-positive CMV AU were included. For each patient, best-corrected visual acuity (BCVA), intraocular pressure (IOP), clinical characteristics at baseline and latest visit, and number of relapses were recorded. All patients received an induction dose of intravenous (IV) ganciclovir or oral valganciclovir and a maintenance dose of oral valganciclovir.. Thirty-six eyes of 35 patients were included. Mean age at diagnosis was 55.5 years. Mean follow-up was 4.13 years. Posner-Schlossman and chronic nonspecific AU were observed in 69.4% and 30.6% of cases, respectively. We did not observe any case of Fuchs uveitis or endotheliitis. At baseline, mean BCVA was 20/25 and mean IOP was 29.19 mm Hg. Keratic precipitates and iris atrophy were seen in 91.4% and 25.7% of cases. Induction therapy consisted of oral valganciclovir and IV ganciclovir in 40% and 60% of cases. A total of 94.2% of patients responded to the first line of therapy. Recurrence was reported in 73.5% of cases. Glaucoma surgery was necessary in 25.7% of cases. Early initiation of antiviral therapy (≤700 days) seemed to decrease the recourse to glaucoma surgery. Both IV and oral induction treatments seemed similar in terms of BCVA changes and occurrence of relapses.. Characteristics of CMV AU seem to show specificities in this French cohort. Early initiation of antiviral therapy seems to reduce the severity of glaucoma.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; France; Ganciclovir; Humans; Infusions, Intravenous; Intraocular Pressure; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Treatment Outcome; Uveitis, Anterior; Valganciclovir; Visual Acuity; Young Adult

The purpose of this study is to elucidate the clinical manifestations and the current treatment status of cytomegalovirus (CMV) endotheliitis via a large case series obtained from a national survey conducted in Japan.. The Japan Corneal Endotheliitis Study Group proposed diagnostic criteria for CMV endotheliitis based on a viral examination by PCR of aqueous humour, in combination with clinical manifestations. A national survey was then retrospectively conducted among 1160 members of the Japan Cornea Society. The study reviewed the patient profiles, clinical manifestations, and treatment modalities of individuals who met the diagnostic criteria for CMV endotheliitis.. The study included 109 eyes of 106 patients. Mean patient age was 66.9±10.9 years (85 males (80.2%), 21 females (19.8%)). Patients were commonly diagnosed with anterior uveitis and ocular hypertension prior to confirmation of CMV endotheliitis. Coin-shaped lesions were observed in 70.6%, and linear keratic precipitates in 8.3% of the patients, respectively. 95% of cases were treated with anti-CMV drugs.. CMV endotheliitis is most common in middle-aged and elderly men. CMV endotheliitis should be suspected when patients present with corneal endotheliitis involving coin-shaped lesions accompanied by anterior uveitis and ocular hypertension.

Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Cell Count; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Endothelium, Corneal; Eye Infections, Viral; Female; Ganciclovir; Humans; Intraocular Pressure; Japan; Keratitis; Male; Middle Aged; Ocular Hypertension; Polymerase Chain Reaction; Sex Distribution; Uveitis, Anterior; Valganciclovir; Visual Acuity

To assess the short-term and long-term efficacy of oral therapy with valganciclovir in patients with Posner-Schlossman Syndrome (PSS).. This is a retrospective observational study on 11 patients with PSS treated with valganciclovir. The PSS was diagnosed clinically on the basis of recurrent episodes of anterior uveitis associated with attacks of elevated intraocular pressure (IOP). All patients who did not respond to aciclovir, or whose cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) analysis of the aqueous humour was positive, were treated with valganciclovir (Valcyte®). Initially, the drug was given 900 mg twice daily for 3 weeks, followed by 450 mg twice daily for a mean period of 20 months (range 10-46 months).. Eleven patients with mean age of 44 years were included in this study. Four of 11 patients were working in a sanitary profession. Before initiation of valgancicloivir therapy, the highest IOP was 68 mmHg (mean 45 mmHg ±9 mmHg). In the first week of treatment, the IOP decreased significantly (mean 16 mmHg ±10 mmHg) and maintained stability during the entire treatment period. In seven of 11 (63.6 %) patients, valganciclovir led to resolution of inflammatory activity and stable IOP. In six patients, the therapy could be discontinued after a mean of 14 months. However, two patients had a recurrence after discontinuation of valganciclovir treatment. No side effects of therapy were observed.. Long-term oral therapy with valganciclovir seems to lower the recurrence rate in patients with clinically diagnosed PSS.

Topics: Administration, Oral; Adult; Antihypertensive Agents; Antiviral Agents; Aqueous Humor; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Ganciclovir; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Polymerase Chain Reaction; Retrospective Studies; Syndrome; Treatment Outcome; Uveitis, Anterior; Valganciclovir

To describe 7 cases of unilateral, chronic and/or recurrent anterior uveitis caused by cytomegalovirus (CMV) in immunocompetent patients; to identify specific ophthalmologic characteristics; and to evaluate the clinical effect of valganciclovir treatment.. Retrospective observational case series.. Immunocompetent patients (n = 7) with a history of chronic and/or recurrent unilateral anterior uveitis and a positive analysis for either CMV-DNA and/or antibodies against CMV in their aqueous humor (Goldmann-Witmer coefficient > 3).. Full ophthalmologic examination, anterior chamber fluid analysis, serologic examination, and systemic evaluation. Treatment modalities included topical steroids, topical and/or systemic antiglaucoma medications, glaucoma surgery, and systemic valganciclovir.. Visual acuity, inflammation, and intraocular pressure (IOP).. Chronic unilateral anterior uveitis was seen in 6 patients, whereas recurrent uveitis was observed in 1. Additional findings consisted of slight iris atrophy and secondary glaucoma (n = 3), secondary glaucoma without iris abnormalities (n = 3), and a slightly elevated IOP without iris abnormalities (n = 1). Examinations of the aqueous humor by polymerase chain reaction demonstrated CMV-DNA in 6 patients and were negative for other herpes viruses in all. Goldmann-Witmer coefficients were strongly positive in 4 out of 5 patients. Other laboratory investigations were within normal limits. No other causes for uveitis were identified. Because of the insufficient effect of topical steroids and antiglaucoma medications, 5 patients were treated with additional oral valganciclovir with good clinical response in terms of uveitis activity and IOP. Discontinuation of valganciclovir in 1 patient resulted in a prompt recurrence of uveitis activity.. Cytomegalovirus may cause a chronic and/or recurrent anterior uveitis in otherwise healthy patients. Iris atrophy and glaucoma may accompany it, but an inflammatory reaction in the anterior chamber may be the only sign. Aqueous humor analysis is of the utmost importance in differentiating between CMV and other herpes viruses and in making a definite diagnosis in chronic anterior uveitis. Valganciclovir may be very effective in treating CMV anterior uveitis, but its exact role can only be determined in larger studies with a longer follow-up.

Topics: Adult; Anterior Chamber; Antiviral Agents; Aqueous Humor; Atrophy; Child; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Female; Ganciclovir; Glaucoma; Humans; Immunocompetence; Intraocular Pressure; Iris; Male; Middle Aged; Recurrence; Retrospective Studies; Uveitis, Anterior; Valganciclovir; Visual Acuity

Topics: Antihypertensive Agents; Antiviral Agents; Aqueous Humor; Body Fluids; Corneal Edema; Corneal Stroma; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Ganciclovir; Humans; Intraocular Pressure; Keratomileusis, Laser In Situ; Male; Middle Aged; Myopia; Polymerase Chain Reaction; Postoperative Complications; Surgical Flaps; Trabeculectomy; Uveitis, Anterior; Valganciclovir

To describe the diagnostic and therapeutic management of cytomegalovirus (CMV) anterior uveitis unassociated with retinal necrosis in immunocompetent patients.. Patients referred between 2001 and 2003 for management of unilateral, chronic, recurrent uveitis associated with secondary glaucoma underwent extensive investigation including laboratory tests for herpes virus infections. Specific antiviral treatment was initiated in all cases and the level of ocular inflammation was evaluated during the follow up.. Five patients, three men and two women, were included. Median age was 50 years old (range 30-80 years). Anterior unilateral uveitis without iris atrophy was observed in all cases. Uveitis was chronic in three cases and recurrent in two cases. Glaucoma was observed in all patients with a median intraocular pressure of 30 mm Hg (range 22-43 mm Hg). Five patients responded initially to specific anti-CMV therapy. Even though glaucoma surgery was necessary in two cases, both ocular inflammation and glaucoma were controlled in all cases. Relapses occurred in three cases after cessation of therapy, requiring prolonged maintenance therapy with valganciclovir.. CMV infection and specific antiviral therapy should be considered in all cases of relapsing or chronic iridocyclitis and secondary glaucoma. Maintenance regimens of valganciclovir may be necessary to prevent further relapses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Chronic Disease; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Foscarnet; Ganciclovir; Glaucoma, Open-Angle; Gonioscopy; Humans; Iridocyclitis; Male; Middle Aged; Recurrence; Retrospective Studies; Uveitis, Anterior; Valganciclovir; Vitreous Body