Efficacy of Intravitreal Ganciclovir Injection with or without Oral Valganciclovir versus Topical 2% Ganciclovir for Cytomegalovirus Anterior Segment Infection.

Abstract

Purpose: To compare the effectiveness of the following two treatment approaches for cytomegalovirus (CMV) anterior segment infection: 1) intravitreal injection of ganciclovir as a loading dose with or without adjunctive oral valganciclovir and 2) topical application of 2% ganciclovir.

Methods: We retrospectively reviewed the records of patients diagnosed with CMV anterior segment infection. Patients were categorized into two groups. Group 1 comprised patients who received intravitreal injection of ganciclovir as a loading dose with or without adjunctive oral valganciclovir (n = 48), and group 2 comprised patients who received long-term topical 2% ganciclovir treatment (n = 32). The primary outcome was recurrence-free survival, and the secondary outcomes were changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA).

Results: The recurrence rate over the 2-year follow-up was similar in both group 1 and group 2 (35.4% and 34.4%, respectively; p = 1.0). A Kaplan-Meier plot revealed comparable recurrence-free survival (P for log-rank test = 0.958). Both treatment groups exhibited a notable decrease in IOP. BCVA varied over time; however, no differences were observed between the two groups. In group 1, 39 of 48 patients (81.3%) required adjunctive oral valganciclovir, which was taken for a median duration of 55 days.

Conclusions: Despite being a short-term treatment, intravitreal injection of ganciclovir as a loading dose with or without additional oral valganciclovir comparably and effectively prevents recurrence relative to the long-term topical application of 2% ganciclovir.