Antiviral therapy prevents recurrence in CMV-AU

A recent study has observed a very high recurrence rate for cytomegalovirus (CMV) anterior uveitis (AU), but this can be resolved by antiviral therapy.

Patients with CMV-AU (n=136) who received antiviral therapy from May 2015 to March 2024 were included in this retrospective cohort study conducted in a tertiary ophthalmic centre and a uveitis-specialized private clinic.

The investigators retrospectively analysed clinical records across the study period. Patients received a 6-week course of oral valganciclovir, followed by 0.15% ganciclovir ointment (oral-to-0.15% group), or continuous treatment with 2% topical ganciclovir (2% topical group). They then compared the rates of recurrence for the year before and after treatment initiation.

Kaplan‒Meier analysis was performed to assess recurrence-free survival. A severe corneal endothelial cell (EC) loss was characterized by ≥5-percent yearly loss from baseline. The median follow-up was 27 months (346.8 person-years).

The recurrence rate dropped from 2.87 person-years pretreatment to 1.16 person-years post-treatment (59.6-percent reduction; p<0.0001). Ninety-eight patients (72.0 percent) experienced recurrence after treatment. The median recurrence-free survival was 5.0 months (95 percent confidence interval [CI], 3.4‒6.6), with a 31.0-percent recurrence-free survival at 1 year.

The rates of recurrence decreased by 54.3 percent in the oral-to-0.15% group (n=113) and by 78.8 percent in the 2% topical group (n=23). Recurrences did not occur during the initial 6-week oral valganciclovir phase.

Patients in the 2% topical group were more likely to experience severe EC loss than those in the oral-to-0.15% group (70.0 percent vs 34.4 percent; p=0.003).

In multivariate analysis, 2% topical treatment correlated with severe EC loss compared with the-oral-to-0.15% regimen (B=3.68; p=0.032) following adjustments for age, sex, total follow-up period, and total recurrence number.

“Oral valganciclovir preserved corneal EC better than 2% ganciclovir but featured increased recurrence after step-down to the 0.15% ganciclovir,” the investigators said.