Purpose

To present current practice patterns in the diagnosis and management of Cytomegalovirus anterior uveitis (CMV AU) by uveitis experts worldwide.

Methods

A two-round online-based 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. Based on existing evidence, a working group identified gaps in clinical care regarding the management of CMV AU

Results

Seventy-five experts completed both surveys. In terms of diagnostic theme, experts regarded unilaterally and raised IOP as quite specific CMV AU signs, although variations are common. About 73.3% of the experts always perform an aqueous tap in a suspected case of CMV AU. Most experts consider the use of topical ganciclovir gel 0.15% (70%) and oral valganciclovir (78%) as the first-line topical and systemic antiviral drugs, respectively. Initiation with only topical or combination with systemic treatment was highly variable (13% and 33%, respectively). Topical prednisolone acetate 1% four times daily for one to two weeks with subsequent adjustment depending on the response was preferred (77% of experts) along with antiviral coverage. Long-term maintenance treatment can be considered for up to 12 months, particularly in chronic (88% of experts) and those with at least 2 episodes of CMV AU within a year (75-88% of experts).

Conclusions

Preferred management practices for CMV AU vary widely. A platform for further research to refine diagnosis and management and provide higher-level evidence is deemed necessary.