Long-term structural impact and antiviral efficacy of cytomegalovirus anterior uveitis - results from a 10-year ocular inflammation registry.

Authors

Yung-Ray Hsu, Ming-Shan Cheng, Jia-Kang Wang

Published in

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. Jul 08, 2026. Epub Jul 08, 2026.

Abstract

To evaluate criteria-based long-term structural outcomes and dose-dependent antiviral effects in cytomegalovirus anterior uveitis (CMV AU).
From a 10-year ocular inflammation registry comprising 1,404 patients, 79 eyes from 67 patients with PCR-confirmed CMV AU were identified (mean follow-up, 48 ± 38 months). Serial assessments included retinal nerve fiber layer (RNFL) thickness, corneal endothelial cell density (ECCD), and visual field testing. Criteria for manifest glaucoma were defined as RNFL ≤ 75 μm, interocular asymmetry ≥ 15 μm, or visual field defects; manifest ECCD loss as ≥ 20% interocular difference or ECCD ≤ 1500 cells/mm². Initial treatment response (ITR) was defined as IOP normalization and inflammation reduction within 2 weeks. Flare-up rates were compared between high-dose (2% ganciclovir ≥ QID) and low-dose (2% ganciclovir ≤ TID) topical regimens.
The mean age was 56.5 ± 15.5 years, and 82.1% had unilateral disease. Median diagnostic delay was 33 months; 20.9% required repeat aqueous taps. ITR was achieved in 87.6%. High-dose topical antivirals reduced flare-ups 2.25-fold vs. low-dose regimens (0.471 vs. 1.058 events/eye-year; relative risk = 0.45). Glaucoma rose from 30.3% to 62.0% and ECCD loss from 27.8% to 57.0% during follow-up. Kaplan-Meier analysis showed a median time of 9 years from symptom-onset to manifest glaucoma. Above-midline KPs were inversely associated with peak IOP on linear regression (p < 0.001).
CMV AU poses significant long-term structural risk despite good short-term control. Early criteria-based treatment and high-dose antivirals reduce relapse, while lifelong maintenance is required in eyes with advanced disease.

PMID:
42417849
Bibliographic data and abstract were imported from PubMed on 08 Jul 2026.

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