Impact of glaucoma surgery on recurrence rate in cytomegalovirus anterior uveitis

In cytomegalovirus-induced anterior uveitis (CMV-AU), frequent recurrences are the primary cause of glaucomatous damage and corneal endothelial cell loss, yet factors influencing such recurrences remain unclear. Our study aims to investigate the impact of glaucoma surgery (GS) on recurrence rate in patients with CMV-AU.

This retrospective study included 149 immunocompetent patients with CMV-AU treated with antiviral medication following PCR confirmation. Patients were divided into two groups: the surgery group, consisting of individuals who underwent GS (glaucoma filtering surgery (GFS) or glaucoma drainage device (GDD) implantation), and the medication group, comprising those managed with antiviral therapy alone. Recurrence rates, expressed as episodes per person-year (PY), were documented in the year prior to treatment initiation (from the symptoms onset to treatment start) and those occurring during or after treatment until the end of the follow-up period.

The median follow-up time was 29 months, with a total of 358 person-years (PYs) of follow-up. In the surgery group (n=24), 18 patients (75%) underwent GFS as initial GS, of whom 6 (33.3%) required additional GDD surgery within 1 year due to uncontrolled intraocular pressure. Recurrence rate dropped from 2.39 to 0.54 PYs in the surgery group (n=24), representing a 77.4% reduction (p=0.001). The medication group (n=125) saw a reduction from 2.92 to 1.20 PYs (58.9% reduction; p<0.001). Overall, recurrence rates were 0.45 times lower in the surgery group compared with the medication group (p<0.0001). Kaplan-Meier analysis showed a longer time to first recurrence in the surgery group (48.3 vs 20.5 months; p=0.006); however, corneal endothelial cell density decreased from 1801±629.5 cells/mm² to 1522.9±715.8 cells/mm² in the surgery group (p=0.046).

GS significantly reduced recurrence rate by 77.4% in patients with CMV-AU.