title: Efficacy and safety of topical ganciclovir in the management of cytomegalovirus (CMV)-related anterior uveitis.
abstract: BACKGROUND
  The aim of this study was to evaluate the efficacy and safety of topical ganciclovir 0.15 % gel in the management of patients with cytomegalovirus (CMV) anterior uveitis.
  
  
  RESULTS
  This was a retrospective cohort study of the disease course of 31 patients (33 eyes) with aqueous polymerase chain reaction (PCR) positive for CMV. Data from a total of 160 episodes of anterior uveitis flare for 20 years, dating from December 1992 to December 2012, was collected. All patients were treated with concomitant topical anti-inflammatory medication. The disease course of each eye was analysed before and after the use of topical ganciclovir 0.15 %. The mean age at initial presentation of anterior uveitis was 57.5 ± 12.6 years. Twenty-eight (90.3 %) patients were Chinese. Patients on topical ganciclovir gel had a statistically significant fewer episodes of uveitis flare per person year (median -0.88 episodes/person years, p = 0.029). The time-to-quiescence was not significantly affected by topical ganciclovir use (median -1.25 days, p = 0.610). In the survival analysis using the Cox regression model, the use of topical ganciclovir was associated with a lower risk of recurrence, but this was not statistically significant (hazard ratio = 0.857, 95 % CI 0.543-1.36, p = 0.511). The overall median time-to-recurrence was 290 days (95 % CI 113 to 274 days) and 164 days (125 to 404 days) (p = 0.492), with and without topical ganciclovir, respectively.
  
  
  CONCLUSIONS
  Topical ganciclovir may be beneficial in reducing the frequency of recurrence in patients with CMV anterior uveitis, but it was not statistically associated with prolonging the time-to-recurrence. The time-to-quiescence was also not significantly affected by topical ganciclovir. Prospective studies with a larger number of patients would be required to verify our findings.
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore. john_wong@ttsh.com.sg.
authors.forename: John X H
authors.initials: JX
authors.lastname: Wong
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
authors.forename: Elizabeth P Y
authors.initials: EP
authors.lastname: Wong
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.|Eagle Eye Centre, Singapore, Singapore.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Teoh
keywords: CMV anterior uveitis; Recurrence of anterior uveitis; Topical ganciclovir