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<article article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Czech and Slovak Ophthalmology</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">342</article-id>
      <article-id pub-id-type="doi">10.31348/2024/40</article-id>
      <article-categories>
        <subj-group>
          <subject>Original article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Cytomegalovirus Anterior Uveitis</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Kotingová</surname>
            <given-names>Veronika</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Fichtl</surname>
            <given-names>Marek</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1810-4708</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Brichová</surname>
            <given-names>Michaela</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7154-1427</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Svozílková</surname>
            <given-names>Petra</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9221-0210</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Klímová</surname>
            <given-names>Aneta</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3658-4429</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rezková</surname>
            <given-names>Lucie</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Škrlová</surname>
            <given-names>Eva</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Heissigerová</surname>
            <given-names>Jarmila</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2614-4681</contrib-id>
        </contrib>
      </contrib-group>
      <pub-date date-type="pub" publication-format="electronic">
        <day>14</day>
        <month>10</month>
        <year>2024</year>
      </pub-date>
      <issue>2</issue>
      <elocation-id>2</elocation-id>
      <abstract>
        <p>Aim: The aim of the article is to summarize observations on cytomegalovirus (CMV) anterior uveitis, and in short case reports present cases of patients treated at our Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague. Material and methods: Retrospective analysis of patients at the Centre for diagnosis and treatment of uveitis from 2003 to 2024. Presentation of our experiences with CMV anterior uveitis confirmed by polymerase chain reaction (PCR) in aqueous humor in case reports. Results: From a cohort of 3844 patients with uveitis, 3 patients were diagnosed with CMV anterior uveitis, confirmed by PCR in the aqueous humor. The clinical presentation was as acute recurrent hypertensive anterior uveitis in all patients, with a switch to chronic form with elevated intraocular pressure (IOP). Despite local anti-inflammatory and antiglaucomatous therapy, there was high recurrence of uveitis with decompensation of IOP when the medication was reduced. Patients underwent antiglaucoma surgery because of persistent high IOP despite maximal local antiglaucomatous therapy. An anterior chamber tap was taken for PCR analysis, with a CMV-positive result. After the initiation of antiviral therapy with local ganciclovir, patients manifested compensated IOP and a pronounced reduction of recurrences of uveitis and progression of glaucoma. Conclusions: CMV anterior uveitis is a rare pathology in our geographic region, but it is important to consider this etiology in cases of recurrent anterior hypertensive uveitis with a low response to local anti-inflammatory medication. Timely verification of the etiological agent with prompt diagnosis and treatment is essential in order to achieve a favorable prognosis. Long-term, low maintenance doses of antiviral therapy with local ganciclovir for several months reduce relapses of uveitis and lead to compensation of IOP.</p>
      </abstract>
      <kwd-group>
        <kwd>cytomegalovirus</kwd>
        <kwd>anterior uveitis</kwd>
        <kwd>secondary glaucoma</kwd>
        <kwd>ganciclovir</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <back>
    <ref-list>
      <title>References</title>
      <ref id="R1009">
        <mixed-citation>Shu-Wen CHN, CHee SP, Caspers L, Bodaghi B. Clinical Features of CMV-Associated Anterior Uveitis. Ocul Immunol Inflamm. 2018;26(1):107-115.</mixed-citation>
      </ref>
      <ref id="R1010">
        <mixed-citation>Zhang J, Kamoi K, Zong Y,Yang M, Ohno-Matsui K. Cytomegalovirus Anterior Uveitis: Clinical Manifestations, Diagnosis, Treatment, and Immunological Mechanisms. Viruses. 2023 Jan 9;15(1):185.</mixed-citation>
      </ref>
      <ref id="R1011">
        <mixed-citation>Babu K, Konana VK, Ganesh SK et al.Viral anterior uveitis. Indialn J Ophthalmol. 2020 Sep;68(9):1764-1773.</mixed-citation>
      </ref>
      <ref id="R1012">
        <mixed-citation>Ye Z, Yang Y, Ke W, Li Y, Wang K, Chen M. Overview and update on cytomegalovirus-associated anterior uveitis and glaucoma. Front Public Health. 2023 Mar 1;11:1117412.</mixed-citation>
      </ref>
      <ref id="R1013">
        <mixed-citation>La Distia NR, Putera I, Mayasari YD, et al. Clinical characteristics and treatment outcomes of cytomegalovirus anterior uveitis and endotheliitis: A systematic review and meta-analysis. Surv Ophthalmol. 2022 Jul-Aug;67(4):1014-1030.</mixed-citation>
      </ref>
      <ref id="R1014">
        <mixed-citation>Gozzi F, Gentile P, De Simone L, et al. Viral anterior uveitis. Saudi J Ophthalmol. 2022 Dec 27;36(4):356-364.</mixed-citation>
      </ref>
      <ref id="R1015">
        <mixed-citation>The Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for Cytomegalovirus Anterior Uveitis. Am J Ophthalmol. 2021 Aug:228:89-95.</mixed-citation>
      </ref>
      <ref id="R1016">
        <mixed-citation>Relvas LJM, Antoun J, de Groot-Mijnes JDF, et al. Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers. Ocul Immunol Inflamm. 2018;26(1):116-121.</mixed-citation>
      </ref>
      <ref id="R1017">
        <mixed-citation>Okomkwo ON, Zeppieri M, Tripathy K. Posner-Schlossman Syndrome. StatPearls Publishing. 2024 Jan. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK576412/</mixed-citation>
      </ref>
      <ref id="R1018">
        <mixed-citation>Elia M, Huang JJ, Gaudio PA. Cytomegalovirus Anterior Uveitis in Immunocompetent Patients EyeNet Magazine. May 2016. Available from: https://www.aao.org/eyenet/article/cytomegalovirus-anterior-uveitis-in-immunocompeten</mixed-citation>
      </ref>
      <ref id="R1019">
        <mixed-citation>Kam KW, Mok E, Ho M, et al. Iris depigmentation and cytomegalovirus in aqueous humor as predictors of uveitic activity and recurrence in chronic and recurrent anterior uveitis. Indian J Ophthalmol. 2023 Dec 1;71(12):3684-3689.</mixed-citation>
      </ref>
      <ref id="R1020">
        <mixed-citation>Fan X, Li Z, Zhai R, Sheng Q, Kong X. Clinical characteristics of virus-related uveitic secondary glaucoma: focus on cytomegalovirus and varicella zoster virus. BMC Ophthalmol. 2022 Mar 22;22(1):130.</mixed-citation>
      </ref>
      <ref id="R1021">
        <mixed-citation>Gozzi F, Belloni L, Aldigeri R, et al. Aqueous Humor Analysis in Overlapping Clinical Diagnosis of Cytomegalovirus and Rubella Virus Anterior Uveitis. Medicina (Kaunas). 2022 Aug 4;58(8):1054.</mixed-citation>
      </ref>
      <ref id="R1022">
        <mixed-citation>Ding K, Nataneli N. Cytomegalovirus Corneal Endotheliitis. Stat- Pearls Publishing. 2024 Jan. Available from: https://www.ncbi.nlmnih.gov/books/NBK578174/</mixed-citation>
      </ref>
      <ref id="R1023">
        <mixed-citation>Wong AHY, Kua WN, Young AL, Wan KH. Management of cytomegalovirus corneal endotheliitis. Eye Vis (Lond). 2021 Jan 14;8(1):3.</mixed-citation>
      </ref>
      <ref id="R1024">
        <mixed-citation>CHoi JA, Kim KS, Jung Y, Park HYL, Park ChK. Cytomegalovirus as a cause of hypertensive anterior uveitis in immunocompetent patients. J Ophthalmic Inflamm Infect. 2016 Dec;6(1):32.</mixed-citation>
      </ref>
      <ref id="R1025">
        <mixed-citation>Harada Y, Nakahira A, Tada K, Sumi T, Fukushima A. Requirement of longer term antiviral therapy in patients with cytomegalovirus anterior uveitis with corneal endothelial cell damage. Clin Ophthalmol. 2018 Jul 25;12:1311-1316.</mixed-citation>
      </ref>
      <ref id="R1026">
        <mixed-citation>Wong JXH, Agrawal R, Wong EP, Teoh SC. Efficacy and safety of topical ganciclovir in the management of cytomegalovirus (CM- V)-related anterior uveitis. J Ophtalmic Inflamm Infect. 2016 Dec;6(1):10.</mixed-citation>
      </ref>
    </ref-list>
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</article>
