valganciclovir and Uveitis

To determine whether treatment with valganciclovir will improve visual acuity in eyes with immune recovery uveitis complicated by macular edema.. Prospective open label controlled Phase II drug study.. Five patients with chronic macular edema as a result of immune recovery uveitis were studied. Baseline fluorescein angiograms, best-corrected ETDRS visions, and cytomegalovirus (CMV) lymphoproliferative T-cell function assays were obtained and repeated after three months of valganciclovir therapy (900 mg daily) and again three months after withdrawal of therapy.. Vision improved by a mean of 11 letters in the treatment phase (P =.05). Graded angiograms showed three patients had treatment reduction of macular edema. One patient had rebound increase in macular edema after the withdrawal phase. The CMV lymphoproliferative response was not affected by the valganciclovir.. Results suggest valganciclovir treatment may benefit visual acuity in patients with macular edema from immune recovery uveitis.

Topics: Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cytomegalovirus Retinitis; Female; Fluorescein Angiography; Ganciclovir; Humans; Immune System; Macular Edema; Male; Prospective Studies; Uveitis; Valganciclovir; Visual Acuity

A 61-year-old male patient presented with decreased vision and recurrent redness in his right eye since the past 4 years. He had been diagnosed elsewhere as HLA-B27 positive anterior uveitis and was on oral methotrexate and topical corticosteroids for recurrent disease. He was on maximal medical therapy for glaucoma. Examination showed prominent inferior corneal oedema with pigmented keratic precipitates and elevated intraocular pressure. He underwent combined trabeculectomy with mitomycin C and cataract surgery. The aqueous sample tested positive for cytomegalovirus. He responded well to oral valganciclovir with resolution of uveitis, the intraocular pressure was well controlled and the corneal oedema resolved completely.

Topics: Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Diagnostic Errors; Endothelium, Corneal; Glaucoma; HLA-B27 Antigen; Humans; Male; Middle Aged; Uveitis; Valganciclovir

Topics: Aged; Antiviral Agents; Cytomegalovirus Retinitis; Female; Ganciclovir; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Uveitis; Valganciclovir

To report a case of cytomegalovirus (CMV) endotheliitis after insertion of an intravitreal fluocinolone acetonide (Retisert) implant.. Interventional case report.. Retrospective chart review.. A 40-year-old man received a Retisert implant in the left eye for recurrent Behçet uveitis. Although inflammation became quiescent within a month, corneal edema developed 4 months after insertion. Polymerase chain reaction analysis for aqueous humor detected 3.9 × 10(4) copies/mL of CMV DNA. After treatment with oral valganciclovir, CMV DNA nearly disappeared but visual outcome was poor due to corneal decompensation resulting from severe endothelial cell loss.. After Retisert implant, clinicians should be attentive to the potential risk of CMV endotheliitis.

Topics: Administration, Oral; Adult; Anti-Inflammatory Agents; Antiviral Agents; Behcet Syndrome; Corneal Edema; Cytomegalovirus Infections; Drug Implants; Endothelium, Corneal; Fluocinolone Acetonide; Ganciclovir; Humans; Inflammation; Male; Uveitis; Valganciclovir; Vision Disorders

Topics: AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4-Positive T-Lymphocytes; Cytomegalovirus Retinitis; Ganciclovir; Humans; Macular Edema; Uveitis; Valganciclovir