Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia.
Surv Ophthalmol. 2022 Jul-Aug;67(4):1014-1030. doi: 10.1016/j.survophthal.2021.12.006. Epub 2021 Dec 23.
Cytomegalovirus (CMV) anterior uveitis is the most common form of ocular manifestation of CMV in immunocompetent individuals. The difficulty in diagnosing CMV anterior uveitis may delay adequate treatment and affect outcomes. We sought to review systemically the overall clinical characteristics and compare treatment outcomes in CMV anterior uveitis and endotheliitis. A literature search was performed, and studies describing clinical characteristics, treatment regimens, and outcomes that included more than 5 treated eyes were included. In these 23 studies, acute CMV anterior uveitis commonly presented with high intraocular pressure (95.31%, 95% CI 90.45-98.60) and mild anterior chamber inflammation (cells >2+ = 3.18%, 95% CI 0.21-0.54). About two-thirds of CMV endotheliitis cases presented with high intraocular pressure and coin-shaped corneal lesions. Acute CMV anterior uveitis showed good clinical response to topical 0.15% ganciclovir (GCV) gel or oral valganciclovir (VGCV) (90%, 95% CI 74-100% and 95%, 95% CI 88-100%, respectively). For chronic CMV anterior uveitis, both topical GCV and oral VGCV yielded comparable results. Topical 0.5-2% GCV or a combination of topical and oral VGCV for CMV endotheliitis both resulted in good clinical response. Recurrence of inflammation was common after cessation of maintenance therapy. Overall, topical GCV resulted in an optimal outcome for CMV anterior uveitis. Escalated concentration and frequency of usage are needed for chronic CMV anterior uveitis and endotheliitis. Adequate induction and maintenance phases of anti-CMV treatment seem necessary to prevent recurrences.
巨细胞病毒（CMV）前葡萄膜炎是免疫功能正常个体中 CMV 眼部表现最常见的形式。CMV 前葡萄膜炎的诊断困难可能会延迟适当的治疗并影响结果。我们旨在系统地回顾 CMV 前葡萄膜炎和内皮炎的总体临床特征，并比较其治疗结果。进行了文献检索，并纳入了描述临床特征、治疗方案和包含 5 只以上治疗眼的结局的研究。在这 23 项研究中，急性 CMV 前葡萄膜炎常表现为高眼压（95.31%，95%CI 90.45-98.60）和轻度前房炎症（细胞>2+ = 3.18%，95%CI 0.21-0.54）。大约三分之二的 CMV 内皮炎病例表现为高眼压和钱币状角膜病变。急性 CMV 前葡萄膜炎对局部 0.15%更昔洛韦（GCV）凝胶或口服缬更昔洛韦（VGCV）治疗有良好的临床反应（90%，95%CI 74-100%和 95%，95%CI 88-100%）。对于慢性 CMV 前葡萄膜炎，局部 GCV 和口服 VGCV 均有相似的效果。局部 0.5-2% GCV 或局部和口服 VGCV 的联合治疗对 CMV 内皮炎均有良好的临床反应。停止维持治疗后炎症复发很常见。总体而言，局部 GCV 是 CMV 前葡萄膜炎的最佳治疗选择。对于慢性 CMV 前葡萄膜炎和内皮炎，需要增加浓度和使用频率。充分的诱导和维持阶段的抗 CMV 治疗似乎是预防复发所必需的。
