Abstract
OBJECTIVE: To characterise the clinical spectrum, prognostic indicators and seasonal relapse patterns of cytomegalovirus anterior uveitis (CMV-AU), with particular emphasis on glaucoma risk and treatment outcomes. METHODS: This retrospective study analysed 53 eyes of 52 immunocompetent patients diagnosed with CMV-AU between 2019 and 2023 at a tertiary referral centre. Diagnosis relied on characteristic clinical findings and, in selected cases, aqueous-humour polymerase chain reaction (PCR) testing. Demographic data, best-corrected visual acuity (BCVA), intraocular pressure (IOP), keratic precipitate (KP) patterns, anterior segment changes, treatment regimens and relapse rates were reviewed. RESULTS: The cohort (67.3% male) had a mean diagnosis age of 34.3±11.1 years. Most eyes were Posner-Schlossmann-like (63.5%), followed by chronic non-specific AU (34.6 %) and Fuchs-like AU (1.9 %). KPs were chiefly solitary (58.5%), centrally located (50.9%) and sparse (< 5) in 66.0 %. Corneal endothelitis occurred in 39.6% of eyes and was an independent predictor of secondary glaucoma (OR=6.20, 95 % CI 1.04-36.86). Glaucoma developed in 56.6% of eyes; 13.2% required glaucoma surgery. Glaucoma was more frequent and more likely to require surgery in patients treated with oral valganciclovir compared to those treated with topical ganciclovir alone (p=0.049 and p=0.034, respectively). Having ≥ 1 winter relapse (OR=4.99, 95 % CI 1.14-21.86) and, in women, ≥1 spring relapse (OR=5.38, 95 % CI 1.11-25.96) independently predicted > 3 relapses. Overall relapse frequency peaked in winter and summer (p<0.05). CONCLUSION: Corneal endothelitis appears to be an independent risk factor for secondary glaucoma in CMV-AU, warranting vigilant IOP monitoring and timely antiviral therapy. The observed seasonal pattern, with more frequent relapses in winter overall and an increased rate in spring among female patients, may assist clinicians in identifying high-risk groups and planning closer follow-up.