Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis.
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.
Department of Ophthalmology, Chang Gung Memorial Hospital and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Yih-Shiou
YS
Hwang
Ken-Kuo
KK
Lin
Jiahn-Shing
JS
Lee
Shirley H L
SH
Chang
Kuan-Jen
KJ
Chen
Chi-Chun
CC
Lai
Jerry Chien-Chieh
JC
Huang
Ya-Hui
YH
Kuo
Ching-Hsi
CH
Hsiao
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D006801:Humans; D007121:Immunocompetence; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D000077562:Valganciclovir; D014792:Visual Acuity; D014822:Vitreous Body
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir