Souska Zandi1, Bahram Bodaghi2, Justus G Garweg1,3. 1. a Clinic for Vitreoretinal Diseases , Swiss Eye Institute and Berner Augenklinik am Lindenhofspital , Bern , Switzerland. 2. b DHU ViewRestore, UPMC , Sorbonne Universities, APHP , Paris , France. 3. c University of Bern , Bern , Switzerland.
Abstract
PURPOSE: To define a clinically tailored therapeutic strategy for the treatment of viral anterior uveitis (VAU). METHODS: A PubMed search spanning the past 5 years was conducted using the MesH-terms "viral anterior uveitis" and "therapy." RESULTS: The herpes simplex virus (HSV), the varicella zoster virus (VZV), and the cytomegalovirus (CMV) are the predominant pathogens in VAU. Other viruses, including rubella, chikungunya, and zika, have been linked with distinct forms of the disease. Depending on the causative agent and the host immunocompetence, the mainstay treatment for suspected VAU is a combination of topical or systemic antivirals and topical corticosteroids, supplemented with cycloplegics and intraocular-pressure-lowering medication. CONCLUSIONS: Oral acyclovir, valacyclovir, and famciclovir are the mainstay of treatment for HSV- and VZV-induced infections. Brivudin serves as an alternative in insufficiently responsive cases. CMV-induced infections respond well to valganciclovir. A 3- to 12-month course of prophylactic treatment against recurrences is worth considering.
PURPOSE: To define a clinically tailored therapeutic strategy for the treatment of viral anterior uveitis (VAU). METHODS: A PubMed search spanning the past 5 years was conducted using the MesH-terms "viral anterior uveitis" and "therapy." RESULTS: The herpes simplex virus (HSV), the varicella zoster virus (VZV), and the cytomegalovirus (CMV) are the predominant pathogens in VAU. Other viruses, including rubella, chikungunya, and zika, have been linked with distinct forms of the disease. Depending on the causative agent and the host immunocompetence, the mainstay treatment for suspected VAU is a combination of topical or systemic antivirals and topical corticosteroids, supplemented with cycloplegics and intraocular-pressure-lowering medication. CONCLUSIONS: Oral acyclovir, valacyclovir, and famciclovir are the mainstay of treatment for HSV- and VZV-induced infections. Brivudin serves as an alternative in insufficiently responsive cases. CMV-induced infections respond well to valganciclovir. A 3- to 12-month course of prophylactic treatment against recurrences is worth considering.
Authors: Jaskirat S Takhar; Ashlin S Joye; Thanapong Somkijrungroj; Wipada Laovirojjanakul; Chang-Ping Lin; Thomas M Lietman; Travis C Porco; Jeremy D Keenan; Elisabeth A Gebreegziabher; Gerami D Seitzman; Jennifer Rose-Nussbaumer; Thuy A Doan; Nisha R Acharya; John A Gonzales Journal: BMJ Open Date: 2019-12-19 Impact factor: 2.692