Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 248; no. 2; pp. 263 - 269
• Main Authors: Hwang, Yih-Shiou, Lin, Ken-Kuo, Lee, Jiahn-Shing, Chang, Shirley H. L., Chen, Kuan-Jen, Lai, Chi-Chun, Huang, Jerry Chien-Chieh, Kuo, Ya-Hui, Hsiao, Ching-Hsi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.02.2010; Springer Nature B.V
• Subjects: Administration, Oral; Adult; Aged; Antiviral Agents - administration & dosage; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - immunology; Female; Follow-Up Studies; Ganciclovir - administration & dosage; Ganciclovir - analogs & derivatives; Humans; Immunocompetence; Inflammatory Disorders; Injections, Intraocular; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Pilot Projects; Treatment Outcome; Uveitis, Anterior - drug therapy; Uveitis, Anterior - immunology; Uveitis, Anterior - virology; Visual Acuity; Vitreous Body; Cytomegalovirus; Intravitreal; Loading ganciclovir; Valganciclovir; Quantitative polymerase chain reaction (qPCR); Uveitis
• ISSN: 0721-832X; 1435-702X; 1435-702X
• DOI: 10.1007/s00417-009-1195-2

Background 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. Methods 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. Results 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. Conclusions 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.