ArticleGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie2026
Long-term structural impact and antiviral efficacy of cytomegalovirus anterior uveitis - results from a 10-year ocular inflammation registry.
Article in Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate criteria-based long-term structural outcomes and dose-dependent antiviral effects in cytomegalovirus anterior uveitis (CMV AU).
methodsFrom 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.
resultsThe 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).
conclusionsCMV 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.
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