Effect of Continuous 0.5% Ganciclovir Eye Drop Treatment in Secondary Glaucoma Associated with Cytomegalovirus Anterior Uveitis

Purpose: The purpose of this study was to investigate the treatment outcomes of secondary glaucoma caused by cytomegalovirus (CMV)-anterior uveitis (AU) with continuous 0.5% ganciclovir eye drop.

Study Design: Retrospective observational study.

Place and Duration of Study: Department of Ophthalmology, Oita University Hospital, between January 2012 and December 2017.

Methodology: Nineteen eyes of 19 patients with secondary glaucoma associated with CMV-AU diagnosed by a polymerase chain reaction analysis from human aqueous samples were enrolled. They were treated with continuous 4-times-daily topical 0.5% ganciclovir in addition to topical steroids and anti-glaucoma medications. We performed glaucoma surgery for patients with poorly medically controlled intraocular pressure (IOP).

Results: Anterior chamber inflammation and IOP were controlled without systemic ganciclovir or glaucoma surgery during the follow-up period (mean: 59.2±27.0 months) in 9 (47%) eyes. Five (26%) eyes required systemic ganciclovir and ten (53%) eyes required glaucoma surgery. Patients were divided into two groups for the comparison: one group requiring glaucoma surgery and one treated with medication. The mean IOP and number of anti-glaucoma medications at the first visit were significantly higher in the surgery group than in the medication group. The mean number of IOP spikes per year (IOP >30 mmHg) was 1.4±0.9 in the surgery group and 0.4±0.5 in the medication group. The recurrence of anterior chamber inflammation was suppressed in both groups. The cumulative survival rate after glaucoma surgery was 80% at 12 months and 70% at 36 months.

Conclusion: The anterior chamber inflammation and IOP were controlled with continuous 0.5% ganciclovir eye drop treatment in half of the patients with CNV-AU. A high IOP at the first visit and frequent IOP spikes were risk factors for additional glaucoma surgeries.Cytomegalovirus