Management of Glaucoma in Cytomegalovirus Uveitis: A Retrospective Case Series of Surgical and Medical Approaches

Cytomegalovirus (CMV) is a double-stranded (dsDNA) virus of the herpesvirus family. Serological tests reveal signs of previous exposure to it in 40% to 100% of the general population. CMV anterior uveitis (AU) is the most common form of ocular manifestation of CMV in immunocompetent individuals. Clinically, it manifests mainly as anterior chamber (AC) inflammation, iris atrophy, and elevated intraocular pressure (IOP). In this study, we presented four cases of CMV AU with high IOP requiring different treatment modalities to control the IOP.  All patients underwent AC paracentesis, and the aqueous sample sent for polymerase chain reaction (PCR) showed CMV DNA. They were treated with ganciclovir ophthalmic gel 0.15% for the infection. For IOP control, patients underwent different surgeries, namely microinvasive glaucoma surgery (MIGS) with XEN implant, augmented trabeculectomy (AT), glaucoma drainage device implantation (GDI), and transscleral cyclophotocoagulation (TSCPC). Patients were then followed up for a period ranging from six months to three years post-intervention to monitor for evidence of recurrence, IOP control, number of topical antiglaucoma medications required, and progression of glaucoma as evidenced by optical coherence tomography (OCT) retina nerve fiber layer (RNFL) and Humphrey visual field (HVF).