Clinical characteristics and treatment outcomes of cytomegalovirus anterior uveitis and endotheliitis: A systematic review and meta-analysis

• Published in: Survey of ophthalmology 2022-07, Vol.67 (4), p.1014-1030
• Main Authors: La Distia Nora, Rina, Putera, Ikhwanuliman, Mayasari, Yuri Dwi, Hikmahwati, Wandya, Pertiwi, Adinda Mulya, Ridwan, Asri Salima, Sitompul, Ratna, Westcott, Mark, Chee, Soon-Phaik, Pavesio, Carlos, Thng, Zheng Xian, Gupta, Vishali, Agrawal, Rupesh
• Format: Article
• Language: English
• Subjects: Anterior uveitis; Antiviral Agents - therapeutic use; Aqueous Humor; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - drug therapy; DNA, Viral - analysis; DNA, Viral - therapeutic use; Endotheliitis; Eye Infections, Viral - diagnosis; Eye Infections, Viral - drug therapy; Ganciclovir; Ganciclovir - therapeutic use; Glaucoma - drug therapy; Humans; Inflammation; Treatment Outcome; Uveitis, Anterior - diagnosis; Uveitis, Anterior - drug therapy; Valganciclovir; Valganciclovir - therapeutic use
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2021.12.006

Cytomegalovirus (CMV) anterior uveitis is the most common form of ocular manifestation of CMV in immunocompetent individuals. The difficulty in diagnosing CMV anterior uveitis may delay adequate treatment and affect outcomes. We sought to review systemically the overall clinical characteristics and compare treatment outcomes in CMV anterior uveitis and endotheliitis. A literature search was performed, and studies describing clinical characteristics, treatment regimens, and outcomes that included more than 5 treated eyes were included. In these 23 studies, acute CMV anterior uveitis commonly presented with high intraocular pressure (95.31%, 95% CI 90.45–98.60) and mild anterior chamber inflammation (cells >2+ = 3.18%, 95% CI 0.21–0.54). About two-thirds of CMV endotheliitis cases presented with high intraocular pressure and coin-shaped corneal lesions. Acute CMV anterior uveitis showed good clinical response to topical 0.15% ganciclovir (GCV) gel or oral valganciclovir (VGCV) (90%, 95% CI 74–100% and 95%, 95% CI 88–100%, respectively). For chronic CMV anterior uveitis, both topical GCV and oral VGCV yielded comparable results. Topical 0.5–2% GCV or a combination of topical and oral VGCV for CMV endotheliitis both resulted in good clinical response. Recurrence of inflammation was common after cessation of maintenance therapy. Overall, topical GCV resulted in an optimal outcome for CMV anterior uveitis. Escalated concentration and frequency of usage are needed for chronic CMV anterior uveitis and endotheliitis. Adequate induction and maintenance phases of anti-CMV treatment seem necessary to prevent recurrences.