Clinical characteristics and treatment outcomes of cytomegalovirus anterior uveitis and endotheliitis: A systematic review and meta-analysis |
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| Institution: | 1. Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia;2. Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands;3. Moorfields Eye Hospital, NHS Foundation Trust, London, UK;4. University College London Institute of Ophthalmology, London, UK;5. Singapore National Eye Centre, Singapore;6. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;7. Postgraduate Institute of Medical Education and Research, Chandigarh, India;8. Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore;9. Singapore Eye Research Institute, Singapore;10. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore;11. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore;1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada;2. Faculty of Medicine, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada;3. Faculty of Medicine, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada;1. Army Medical Services, Singapore Armed Forces, Singapore;2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;4. Department of Ophthalmology, Mayo Clinic, USA;5. Department of Ophthalmology, Woodlands Health Campus, Singapore;1. Department of Ophthalmology, Bretonneau University Hospital of Tours, France;2. UMR 1253, iBrain, Tours, Centre-Val de Loire, France;3. CHRU Tours, Nuclear medicine in vitro department, Tours, France;4. Amyotrophic lateral sclerosis Centre, Department of Neurology, CHRU Tours, France;5. CHRU Tours, Biochemistry and molecular biology department, Tours, France;1. Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA;2. Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt;3. Yale University School of Medicine, New Haven, Connecticut, USA;4. Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Israel;1. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;2. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada;3. Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;4. Kensington Vision and Research Centre, Toronto, Ontario, Canada |
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| Abstract: | 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. |
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