The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2-global current practice patterns for the management of Cytomegalovirus anterior uveitis

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 fr...

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Bibliographic Details
Published in:Eye (London) 2024-01, Vol.38 (1), p.68-75
Main Authors: Thng, Zheng Xian, Putera, Ikhwanuliman, Testi, Ilaria, Chan, Kevin, Westcott, Mark, Chee, Soon-Phaik, Dick, Andrew D, Kempen, John H, Bodaghi, Bahram, Thorne, Jennifer E, Barisani-Asenbauer, Talin, de Smet, Marc D, Smith, Justine R, McCluskey, Peter, La Distia Nora, Rina, Jabs, Douglas A, de Boer, Joke H, Sen, H Nida, Goldstein, Debra A, Khairallah, Moncef, Davis, Janet L, Rosenbaum, James T, Jones, Nicholas P, Nguyen, Quan Dong, Pavesio, Carlos, Agrawal, Rupesh, Gupta, Vishali
Format: Article
Language:English
Subjects:
Acetic acid
Antiviral Agents - therapeutic use
Aqueous Humor
Cytomegalovirus
Cytomegalovirus Infections - diagnosis
Cytomegalovirus Infections - drug therapy
Diagnosis
Ganciclovir
Ganciclovir - therapeutic use
Humans
Management
Prednisolone
Surveys
Uveitis
Uveitis, Anterior - diagnosis
Uveitis, Anterior - drug therapy
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Summary: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.
ISSN:0950-222X
1476-5454
DOI:10.1038/s41433-023-02631-8