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The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2—global current practice patterns for the management of Cytomegalovirus anterior uveitis

Eye volume 38, pages 68–75 (2024)Cite this article

Subjects

Abstract

Aims

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

Methods

A two-round 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.

Results

Seventy-five experts completed both surveys. Fifty-five of the 75 experts (73.3%) would always perform diagnostic aqueous tap in suspected CMV AU cases. Consensus was achieved for starting topical antiviral treatment (85% of experts). About half of the experts (48%) would only commence systemic antiviral treatment for severe, prolonged, or atypical presentation. The preferred specific route was ganciclovir gel 0.15% for topical treatment (selected by 70% of experts) and oral valganciclovir for systemic treatment (78% of experts). The majority of experts (77%) would commence treatment with topical corticosteroid four times daily for one to two weeks along with antiviral coverage, with subsequent adjustment depending on the clinical response. Prednisolone acetate 1% was the drug of choice (opted by 70% of experts). Long-term maintenance treatment (up to 12 months) can be considered for chronic course of inflammation (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. Further research is necessary to refine diagnosis and management and provide higher-level evidence.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

HNS’s work is supported by the NIH Intramural research program (IRP). The funding organisation had no role in the design or conduct of this research. Rupesh Agrawal has received NMRC Clinician Scientist Award from National Medical Research Council, Singapore, but the funding organisation has no role in the design or conduct of this research.

Author information

Author notes

  1. These authors contributed equally: Zheng Xian Thng, Ikhwanuliman Putera.

  2. These authors jointly supervised this work: Rupesh Agrawal, Vishali Gupta.

Authors and Affiliations

  1. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore

    Zheng Xian Thng & Rupesh Agrawal

  2. Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia

    Ikhwanuliman Putera & Rina La Distia Nora

  3. Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands

    Ikhwanuliman Putera & Rina La Distia Nora

  4. Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands

    Ikhwanuliman Putera

  5. National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK

    Ilaria Testi, Mark Westcott, Andrew D. Dick, Carlos Pavesio & Rupesh Agrawal

  6. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

    Kevin Chan & Rupesh Agrawal

  7. Singapore National Eye Centre, Singapore, Singapore

    Soon-Phaik Chee

  8. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Soon-Phaik Chee

  9. University of Bristol, Bristol, UK

    Andrew D. Dick

  10. UCL-Institute of Ophthalmology, London, UK

    Andrew D. Dick & Carlos Pavesio

  11. Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute, Boston, MA, USA

    John H. Kempen

  12. Sight for Souls, Fort Myers, FL, USA

    John H. Kempen

  13. Addis Ababa University Department of Ophthalmology, Addis Ababa, Ethiopia

    John H. Kempen

  14. MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia

    John H. Kempen

  15. Dept of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l’Hopital, 75013, Paris, France

    Bahram Bodaghi

  16. Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Jennifer E. Thorne & Douglas A. Jabs

  17. Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jennifer E. Thorne & Douglas A. Jabs

  18. Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria

    Talin Barisani-Asenbauer

  19. Dept of Ophthalmology, Leiden University, Leiden, Netherlands

    Marc D. de Smet

  20. MIOS sa, Lausanne, Switzerland

    Marc D. de Smet

  21. Flinders University College of Medicine & Public Health, Adelaide, Australia and Queensland Eye Institute, Brisbane, QLD, Australia

    Justine R. Smith

  22. Department of Ophthalmology, Director Save Sight Institute, The University of Sydney, Sydney, NSW, Australia

    Peter McCluskey

  23. Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands

    Joke H. de Boer

  24. National Eye Institute, National Institutes of Health, Bethesda, MD, USA

    H. Nida Sen

  25. Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    Debra A. Goldstein

  26. Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia

    Moncef Khairallah

  27. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA

    Janet L. Davis

  28. Oregon Health and Science University, Portland, OR, USA

    James T. Rosenbaum

  29. Legacy Devers Eye Institute, Portland, OR, USA

    James T. Rosenbaum

  30. School of Biological Sciences, University of Manchester, Manchester, UK

    Nicholas P. Jones

  31. Byers Eye Institute, Stanford Medical School, Palo Alto, CA, USA

    Quan Dong Nguyen

  32. Duke NUS Medical School, Singapore, Singapore

    Rupesh Agrawal

  33. Singapore Eye Research Institute, Singapore, Singapore

    Rupesh Agrawal

  34. Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Vishali Gupta

Authors
  1. Zheng Xian Thng
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  2. Ikhwanuliman Putera
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  3. Ilaria Testi
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  4. Kevin Chan
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  5. Mark Westcott
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  6. Soon-Phaik Chee
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  7. Andrew D. Dick
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  8. John H. Kempen
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  9. Bahram Bodaghi
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  15. Rina La Distia Nora
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  18. H. Nida Sen
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Consortia

on behalf of TITAN consensus guidelines group

  • Zheng Xian Thng
  • , Ikhwanuliman Putera
  • , Rupesh Agrawal
  • , Ilaria Testi
  • , Mark Westcott
  • , Soon-Phaik Chee
  • , Andrew D. Dick
  • , John H. Kempen
  • , Manfred Zierhut
  • , Bahram Bodaghi
  • , Jennifer E. Thorne
  • , Talin Barisani-Asenbauer
  • , Marc D. de Smet
  • , Justine R. Smith
  • , Peter McCluskey
  • , Rina La Distia Nora
  • , Douglas A. Jabs
  • , Joke Boer
  • , H. Nida Sen
  • , Debra A. Goldstein
  • , Moncef Khairallah
  • , Janet L. Davis
  • , Quan Dong Nguyen
  • , Carlos Pavesio
  • , Vishali Gupta
  • , Alan Palestine
  • , Alastair K. Denniston
  • , Alessandro Invernizzi
  • , Amer Radgonde
  • , Amitabh Kumar
  • , Andre Curi
  • , Aniruddha Agarwal
  • , Anita Chan Sook Yee
  • , Annabelle A. Okada
  • , Ariel Schlaen
  • , Arnd Heiligenhaus
  • , Avinash Gurbaxani
  • , S. Bala Murugan
  • , Cecilia S. Lee
  • , Dipankar Das
  • , Edoardo Baglivo
  • , Ester Carreño
  • , J. Fernando Arevalo
  • , Francesco Pichi
  • , Harvey Uy
  • , Hassan A. Al-Dhibi
  • , James T. Rosenbaum
  • , Justus G. Garweg
  • , Jyotirmay Biswas
  • , Kalpana Babu Murthy
  • , Laure Caspers
  • , Luca Cimino
  • , Lyndell L. Lim
  • , Maite Sainz de la Maza
  • , Mamta Agarwal
  • , Manabu Mochizucki
  • , Manisha Agarwal
  • , Marion R. Munk
  • , Massimo Accorinti
  • , Mudit Tyagi
  • , Nicholas P. Jones
  • , Nisha Acharya
  • , Padmamalini Mahendradas
  • , Parthopratim Dutta Majumder
  • , Philip I. Murray
  • , Phoebe Lim
  • , Piergiorgio Neri
  • , Reema Bansal
  • , Russell W. Read
  • , Salil Mehta
  • , Samir S. Shoughy Shawki
  • , Shahana Mazumdar
  • , Shishir Narain
  • , Sofia Androudi
  • , Somasheila Murthy
  • , S. R. Rathinam
  • , Stephen Teoh Charn Beng
  • , Sudharshan Sridharan
  • , Sumita Phatak
  • , Christoph Tappeiner
  • , Timothy Y. Y. Lai
  • , Yew Sen Yuen
  •  & Yun Feng

Contributions

All authors contributed to the intellectual development of this paper. RA and VG conceived and planned the study. ZXT and IP wrote the first draft of the paper. ZXT, IP, IT, KC performed the literature review. ZXT, IP, IT, KC, MW, SPC, ADD, JHK, BB, JET, TBA, MDD, JRS, PM, RLDN, DAJ, JHDB, HNS, DAG, MK, JLD, JTR, NPJ, QDN, CP, RA and VG contributed to interpreting the results and provided critical feedback to the paper. The final version of the paper has been seen and approved by all authors.

Corresponding authors

Correspondence to Rupesh Agrawal or Vishali Gupta.

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Thng, Z.X., Putera, I., Testi, I. et al. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2—global current practice patterns for the management of Cytomegalovirus anterior uveitis. Eye 38, 68–75 (2024). https://doi.org/10.1038/s41433-023-02631-8

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