National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia.
Eye (Lond). 2024 Jan;38(1):68-75. doi: 10.1038/s41433-023-02631-8. Epub 2023 Jul 7.
To present current practice patterns in the diagnosis and management of Cytomegalovirus anterior uveitis (CMV AU) by uveitis experts worldwide.
A two-round modified Delphi survey with masking of the study team was performed. Based on experience and expertise, 100 international uveitis specialists from 21 countries were invited to participate in the survey. Variation in the diagnostic approaches and preferred management of CMV AU was captured using an online survey platform.
Seventy-five experts completed both surveys. Fifty-five of the 75 experts (73.3%) would always perform diagnostic aqueous tap in suspected CMV AU cases. Consensus was achieved for starting topical antiviral treatment (85% of experts). About half of the experts (48%) would only commence systemic antiviral treatment for severe, prolonged, or atypical presentation. The preferred specific route was ganciclovir gel 0.15% for topical treatment (selected by 70% of experts) and oral valganciclovir for systemic treatment (78% of experts). The majority of experts (77%) would commence treatment with topical corticosteroid four times daily for one to two weeks along with antiviral coverage, with subsequent adjustment depending on the clinical response. Prednisolone acetate 1% was the drug of choice (opted by 70% of experts). Long-term maintenance treatment (up to 12 months) can be considered for chronic course of inflammation (88% of experts) and those with at least 2 episodes of CMV AU within a year (75-88% of experts).
Preferred management practices for CMV AU vary widely. Further research is necessary to refine diagnosis and management and provide higher-level evidence.
展示全球葡萄膜炎专家在巨细胞病毒前葡萄膜炎（CMV AU）诊断和治疗方面的当前实践模式。
采用两轮具有研究团队掩蔽的改良 Delphi 调查。基于经验和专业知识，邀请来自 21 个国家的 100 名国际葡萄膜炎专家参与调查。使用在线调查平台捕获 CMV AU 的诊断方法和首选治疗方法的差异。
75 名专家完成了两轮调查。在 75 名专家中，有 55 名（73.3%）专家在疑似 CMV AU 病例中始终进行诊断性房水穿刺。开始局部抗病毒治疗达成共识（85%的专家）。约一半的专家（48%）仅在严重、持久或非典型表现时开始全身抗病毒治疗。首选的具体途径是 0.15%更昔洛韦凝胶用于局部治疗（70%的专家选择）和口服缬更昔洛韦用于全身治疗（78%的专家）。大多数专家（77%）会在开始抗病毒治疗的同时每日四次使用局部皮质类固醇治疗一到两周，随后根据临床反应进行调整。醋酸泼尼松龙 1%是首选药物（70%的专家选择）。对于慢性炎症（88%的专家）和一年内至少有 2 次 CMV AU 发作的患者（75-88%的专家），可以考虑长期维持治疗（长达 12 个月）。
CMV AU 的治疗方法差异很大。需要进一步研究来完善诊断和治疗方法，并提供更高水平的证据。
