Topical versus oral antiviral therapy for cytomegalovirus anterior uveitis: a multicenter study in Taiwan

To compare topical and oral antiviral therapies for cytomegalovirus (CMV) anterior uveitis (AU) in terms of efficacy.

This retrospective study included 240 patients with CMV AU who received treatment at Chang Gung Memorial Hospital between 2007 and 2019. Their diagnoses were confirmed through aqueous polymerase chain reaction.

The mean follow-up duration was 4.0 ± 3.1 years. The proportion of patients with an acute uveitis course, defined as no anti-CMV medication use beyond 3 months after diagnosis, was higher in patients initially treated with oral valganciclovir than in those initially treated with topical ganciclovir (40.0% vs. 15.7%; p = 0.038). Patients initially treated with topical ganciclovir plus oral valganciclovir were least likely to develop chronic disease (combined therapy vs. topical therapy vs. oral therapy: 5.0% vs. 39.3% vs. 20.0%; p = 0.007). Within 3 years, the risk of glaucoma surgery or laser intervention was lower in the acute group compared with the chronic (odds ratio [OR]: 0.25, 95% confidence interval [CI]: 0.08-0.82) and recurrent (OR: 0.32, 95% CI: 0.11-0.92) groups. The risk of corneal transplantation was lower in both the acute and chronic groups compared with the recurrent group (OR: 0.17, 95% CI: 0.05-0.56; and OR: 0.28, 95% CI: 0.09-0.86, respectively).

Compared with topical ganciclovir, oral valganciclovir is associated with a lower risk of recurrent and chronic CMV AU. Chronic and recurrent disease are associated with increased risk of glaucoma requiring intervention, and recurrent disease carries an additional risk of corneal decompensation.