Ganciclovir for the treatment of anterior uveitis

Background Ganciclovir, administered systemically or intraocularly, is effe ctive in controlling cytomegalovirus (CMV) retinitis in immunocompromised p atients. The efficacy of therapy with this antiviral substance was investig ated in an immunocompetent patient with CMV uveitis causing secondary glauc oma. Methods: To identify the presence of an intraocular viral infection, a nterior chamber taps to detect the intraocular synthesis of IgG antibodies and PCR testing were carried out. Clinically, the degree of intraocular inf lammation and the intraocular pressure (IOP) values were monitored. During this time, the patient was treated systemically with ganciclovir administer ed orally and intravenously. Results: The intraocular synthesis of IgG anti bodies specific for CMV was found in two samples of aqueous humor, but nega tive for other viruses. PCR testing was negative for HSV, VZV and CMV at ea ch time. During this time, the patient was treated systemically with gancic lovir administered either intravenously or orally. As a response to therapy with ganciclovir, the elevated IOP values decreased to normal and the intr aocular inflammation declined. After cessation of ganciclovir administratio n, the inflammation and secondary glaucoma recurred. Conclusion: In this ca se of anterior uveitis presumably caused by CMV inducing secondary glaucoma , treatment with ganciclovir led to a decrease of the inflammation and norm alization of IOP. It appears that continuous administration may be required to control the infection in an immunocompetent patient.