Z.X. THNG1, R. AGRAWAL1, S.P. CHEE2, C. PAVESIO3, V. GUPTA4
Tan Tock Seng Hospital1, Singapore National Eye Centre2, Moorfields Eye Hospital3, Advanced Eye Centre4
Cytomegalovirus anterior uveitis (CMV AU) is an increasingly recognized disease entity over the last two decades. There are no guidelines, and little high level published evidence on its management. Our objective is to develop evidence- and experience-based consensus guidelines for the management of CMV AU.
Consensus statements for the management of CMV AU were generated using a two-step Delphi technique. Based on existing evidence, a working group identified gaps in clinical care regarding the management of CMV AU, which was synthesized as the first survey of 31 questions sent to 100 international uveitis specialists in July 2020. Seventeen areas of borderline consensus were identified in the first survey, and these were refined as the second survey, which was conducted in November 2020. The consensus was strong if an agreement of 75% or higher or interquartile range of 0 was achieved, and moderate if an agreement of 66% to 75% or interquartile range of 1 was achieved.
76 uveitis specialists responded. Twelve consensus statements of varying strengths were generated by the two iterative surveys. The international specialists agreed on typical signs of CMV AU, a minimum diagnostic workup and first-line antiviral, anti-inflammatory, and anti-glaucoma therapy. Agreement was also reached on monitoring response to treatment, managing the chronic and recurrent disease, and side effects from therapy.
The consensus guidelines were distilled from available evidence supplemented by the worldwide experience-based practice patterns of uveitis specialists. They serve as an essential reference for ophthalmologists treating the disease and a platform for further research.