A Case Report of Cytomegalovirus-Associated Anterior Uveitis With Atypical Bilateral Circumferential Peripheral Iris Atrophy

Cytomegalovirus-associated anterior uveitis (CMV-AU) is an important subtype of herpesvirus anterior uveitis, usually unilateral and characterized by recurrent iritis, ocular hypertension, pigmented keratic precipitates, iris atrophy, and corneal endothelial dysfunction. We report a 72-year-old immunocompetent man initially diagnosed with bilateral granulomatous uveitis of unknown origin, who was later confirmed by aqueous humor polymerase chain reaction to have CMV-AU. In retrospect, typical features of CMV-AU were present, but the bilateral involvement and atypical diffuse circumferential peripheral iris atrophy contributed to the delayed diagnosis. Corneal endothelial cell loss and trabecular meshwork depigmentation were also observed, consistent with reported CMV-related findings. The patient was treated with topical ganciclovir prepared from an injectable formulation, together with steroids and anti-glaucoma medications. While trabeculotomy provided some intraocular pressure (IOP) reduction, trabeculectomy proved more effective in achieving long-term IOP stability, consistent with previous reports. This case illustrates that CMV-AU may present bilaterally with atypical features and highlights the importance of early recognition, particularly for ophthalmology residents and general ophthalmologists who are not specialized in uveitis or glaucoma.