ClinicalTrials.gg
Not yet recruitingNCT07513623STACCATO I/IIUpdated Aug 11, 2026

Systemic and Topical Antiviral Control of Cytomegalovirus Anterior Uveitis: Treatment Outcomes - Trials I and II

A Phase 2 interventional study of Valganciclovir and Ganciclovir (GCV) in Cytomegalovirus (CMV), Anterior Uveitis and Infectious Uveitis, sponsored by University of California, San Francisco. Not yet recruiting at 6 sites in 3 countries. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-08-11.

Sponsored by University of California, San Francisco · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
117
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The goal of this clinical trial is to compare antiviral treatment strategies for cytomegalovirus (CMV) anterior uveitis - a viral infection causing inflammation inside the front of the eye - in immunocompetent adults aged 18 years and older. The main questions it aims to answer are:

Does oral valganciclovir reduce aqueous humor CMV viral load more effectively than topical ganciclovir 2% eye drops or placebo after 7 days of treatment (Trial I)? Does long-term suppressive antiviral therapy (oral valganciclovir or topical ganciclovir 2% eye drops) reduce the rate of CMV anterior uveitis recurrence over 12 months compared to placebo (Trial II)?

Researchers will compare oral valganciclovir, topical ganciclovir 2% eye drops, and placebo to see if either antiviral treatment reduces viral load and controls eye inflammation more effectively in the short term, and whether long-term antiviral suppression can prevent the disease from coming back after the inflammation has been controlled.

Participants will:

  • Undergo anterior chamber paracentesis (removal of a small amount of fluid from the front of the eye) for PCR testing to confirm CMV as the cause of their eye inflammation before enrollment
  • Be randomly assigned to receive oral valganciclovir 900 mg twice daily, topical ganciclovir 2% eye drops six times daily, or placebo for 7 days (Trial I), in addition to standard steroid eye drops
  • Return for follow-up visits at Day 7 and Day 21 for eye examinations, laboratory blood tests, and a second anterior chamber paracentesis at Day 7 to measure viral load after treatment
  • If eye inflammation is controlled after Trial I, be offered enrollment into Trial II, where they will be randomly assigned to long-term suppressive oral valganciclovir, topical ganciclovir 2% eye drops, or placebo for 12 months, with follow-up visits approximately every 2 months and additional visits if inflammation returns
Read the detailed description

Cytomegalovirus (CMV) anterior uveitis is an increasingly recognized cause of recurrent and chronic ocular inflammation in immunocompetent individuals, accounting for up to 25% of anterior uveitis cases at specialized centers. The condition typically presents with unilateral hypertensive uveitis, coin-shaped or stellate keratic precipitates, and variable anterior chamber inflammation. Without adequate treatment, CMV anterior uveitis can lead to secondary glaucoma from trabecular meshwork damage and corneal endothelial decompensation, both of which may result in permanent vision loss. Diagnosis requires PCR detection of CMV DNA in aqueous humor via anterior chamber paracentesis.

Despite growing recognition, particularly in Asian and Asian-American populations, no randomized controlled trial has previously established an evidence-based treatment protocol. Observational data and small case series suggest that both oral valganciclovir and topical ganciclovir 2% ophthalmic solution can suppress CMV replication and control inflammation, and that some cases improve without antiviral therapy. However, the relative efficacy of these approaches has not been formally compared, and whether long-term antiviral suppression prevents disease recurrence remains undefined. Prior observational work has demonstrated a correlation between higher aqueous CMV DNA viral load and worse anterior segment outcomes, including greater corneal endothelial cell loss, providing biological rationale for targeting viral load as a primary endpoint in a treatment trial.

Study Design: STACCATO is a sequential, double-masked, placebo-controlled randomized clinical trial consisting of two linked sub-studies (Trial I and Trial II) conducted at six international sites: the Francis I. Proctor Foundation at UCSF (clinical and data coordinating center), UCLA, Chulalongkorn University (Bangkok, Thailand), Khon Kaen University (Khon Kaen, Thailand), Chiang Mai University (Chiang Mai, Thailand), and Chang Gung Memorial Hospital (Taoyuan, Taiwan). Both trials employ a three-arm parallel-group design with 1:1:1 allocation. Randomization uses site-stratified permuted blocks (block sizes 3 and 6) to ensure balance across sites. Allocation concealment is maintained through a centralized electronic randomization system. Both participants and treating ophthalmologists are masked to treatment assignment throughout each trial period. Active and matching placebo tablets and eye drops are identical in appearance, packaging, and administration schedule.

Trial I: Acute Treatment (7-Day Intervention) Trial I evaluates the short-term virologic and clinical effects of antiviral therapy in participants with PCR-confirmed active CMV anterior uveitis. Participants are randomized to one of three treatment arms: Arm 1: oral valganciclovir 900 mg (two 450 mg tablets) twice daily for 7 days, plus matching placebo eye drops six times daily; Arm 2: topical ganciclovir 2% ophthalmic solution six times daily for 7 days, plus matching placebo tablets twice daily; Arm 3: matching placebo tablets twice daily plus matching placebo eye drops six times daily. All participants receive topical prednisolone acetate 1% as standard of care for inflammation control; ocular hypotensive medications are added as clinically indicated for intraocular pressure management.

The primary endpoint of Trial I is log10-transformed aqueous humor CMV viral load at Day 7, measured by quantitative PCR (qPCR) at the central laboratory (Stanford University). Aqueous humor samples are obtained at baseline (Exam 0, pre-enrollment paracentesis) and at Day 7 (Exam 2) via anterior chamber paracentesis; approximately 100 µL are collected at each visit, of which approximately 50 µL is used for local directed qualitative PCR testing for eligibility determination (CMV, HSV, and VZV), and the remaining sample is stored at -80°C and shipped to the central laboratory for quantitative CMV PCR analysis. The pre-specified aqueous lower limit of quantitation (LLOQ) is 2,700 IU/mL (3.43 log10 IU/mL), based on the assay's plasma-validated linear range of 135-6,750,000 IU/mL (2.13-6.83 log10 IU/mL) with 50 µL samples diluted to 1 mL. Viral load values reported as not detected are imputed using maximum likelihood estimation (MLE) in the primary analysis, with sensitivity analyses employing alternative imputation strategies.

Secondary endpoints in Trial I include: (1) proportion of participants achieving clinical inactivity (≤0.5+ anterior chamber cell per SUN criteria) at Days 7 and 21; (2) intraocular pressure (IOP) in mmHg at Days 7 and 21; and (3) visual acuity (logMAR) at Days 7 and 21. A nested observational analysis evaluates the effect of pre-enrollment topical corticosteroid use on baseline aqueous CMV viral load.

Trial II: Long-Term Suppressive Therapy (12-Month Follow-up) Trial II evaluates whether long-term antiviral suppression reduces the rate of inflammatory recurrence in participants who have achieved clinical quiescence following PCR-confirmed CMV anterior uveitis. Participants may enter Trial II via two pathways: (1) participants who complete Trial I and subsequently achieve clinical inactivity, defined as ≤0.5+ anterior chamber cell sustained for at least 2 weeks with a minimum 2-week washout from antiviral therapy; or (2) patients with previously PCR-confirmed CMV anterior uveitis who are already clinically inactive and have not participated in Trial I.

Upon enrollment, participants are re-randomized (independently of their Trial I assignment) to one of three long-term suppressive regimens: Arm 1: oral valganciclovir at suppressive dosing for 12 months, plus matching placebo eye drops; Arm 2: topical ganciclovir 2% ophthalmic solution at maintenance dosing for 12 months, plus matching placebo tablets; Arm 3: matching placebo tablets plus matching placebo eye drops for 12 months.

The primary endpoint of Trial II is recurrence of anterior uveitis inflammation, defined as ≥1+ anterior chamber cell, over 12 months of follow-up. Participants are assessed for recurrence at scheduled visits (approximately months 1, 3, 5, 7, 9, 11, and 12 after randomization) and at unscheduled visits prompted by participant-reported symptoms. If recurrent inflammation is detected at any visit, an anterior chamber paracentesis is performed to assess for the presence of detectable CMV viral load in aqueous humor, and the participant exits the study. A secondary endpoint of Trial II is the prevalence of CMV mutations conferring antiviral resistance in aqueous humor at recurrence, assessed by viral genomic sequencing.

Genomic and Translational Aims: Aqueous humor samples from baseline (Trial I, Exam 0) and recurrence visits (Trial II) are subjected to RNA sequencing to characterize host transcriptional signatures and viral genomic features associated with CMV anterior uveitis. Specific hypotheses include: (a) participants who experience recurrent inflammation after antiviral suppression will have a higher prevalence of CMV resistance mutations compared to baseline samples from Trial I; (b) host transcriptional profiles will distinguish CMV-positive from CMV-negative anterior uveitis; and (c) unique transcriptional signatures will be associated with recurrent inflammation in Trial II participants. This aim is designed to identify biomarkers of treatment response and recurrence risk, and to elucidate mechanisms of viral persistence and resistance informing future therapeutic development.

Statistical Analysis Plan Sample Size: Trial I is powered to detect a 0.8 log10 IU/mL difference in post-treatment CMV viral load between oral valganciclovir and each comparator arm. With baseline viral load as a covariate (ANCOVA), 39 participants per arm (117 total) provides 80% power at a two-sided alpha of 0.05, accounting for approximately 10% loss to follow-up. For Trial II, assuming a 25% recurrence rate in the placebo group, 33 participants per arm (99 total) provides 80% power to detect a 36 percentage-point reduction in recurrence risk at a two-sided alpha of 0.05.

Primary Analyses: The primary efficacy analysis for Trial I compares log10-transformed post-treatment viral loads using ANCOVA, adjusting for baseline viral load, treatment arm, and research site. Multiple comparison adjustment uses the max-T method for the two primary comparisons (oral valganciclovir vs. topical ganciclovir 2%, and oral valganciclovir vs. placebo); topical ganciclovir 2% vs. placebo is a pre-specified secondary comparison. The primary analysis for Trial II uses log-binomial regression to evaluate the risk of inflammatory recurrence over 12 months, adjusted for baseline viral load, treatment arm, and research site.

Secondary and Sensitivity Analyses: Secondary clinical endpoints in both trials are analyzed using linear regression (continuous outcomes) or log-binomial regression (binary outcomes) with analogous covariate adjustment. Pre-specified sensitivity analyses for Trial I evaluate robustness to alternative approaches for undetectable viral load values, including substitution with 1 IU/mL, MLE imputation below the LLOQ, exclusion of participants with undetectable pre-treatment viral loads, and binarization by LLOQ or detectability thresholds. Subgroup analyses include stratification by sex and adjustment for glaucoma medication use as a proxy for baseline disease severity.

Interim Analyses and Stopping Rules: An independent Data Safety Monitoring Board (DSMB) will review accumulating safety and efficacy data at scheduled intervals throughout both trials. Formal interim efficacy analyses employ the O'Brien-Fleming alpha spending approach to preserve overall Type I error. The DSMB has authority to recommend early study modification or termination for safety or overwhelming efficacy.

Prior Work: Pilot STACCATO Trial The current study builds on the completed pilot STACCATO trial (NCT03586284), which enrolled 51 participants across three sites (UCSF, Chulalongkorn University, and Khon Kaen University) between January 2020 and March 2024. The pilot demonstrated feasibility of double-masked RCTs with repeated anterior chamber paracentesis in CMV anterior uveitis. Oral valganciclovir produced the largest absolute reduction in aqueous CMV viral load at Day 7 (0.44 log10 IU/mL), though between-arm differences did not reach statistical significance in this underpowered cohort (early termination due to COVID-19). Baseline and Day 7 viral loads were strongly correlated (Pearson's r=0.774). No serious procedural complications (endophthalmitis, traumatic cataract) were observed. The current study is powered to detect the virologic and clinical differences suggested by these pilot data.

Study Oversight and Data Management The study is overseen by an independent DSMB comprising a uveitis/ocular infectious disease specialist, a biostatistician with clinical trial expertise, and an infectious disease/antiviral pharmacology specialist, none affiliated with the participating institutions. Study data are captured in a validated electronic data capture system with built-in range checks and logic validation; source data verification is conducted at each site. Quantitative PCR analyses of all aqueous humor samples are performed at the central laboratory (Stanford University) to ensure assay comparability across sites and throughout the study period. The study is funded by the National Eye Institute-National Institutes of Health.

02

Conditions studied

  • Cytomegalovirus (CMV)
  • Anterior Uveitis
  • Infectious Uveitis
  • CMV Infection

Keywords

  • Infectious uveitis
  • CMV anterior uveitis
03

In context

Uveitis, Anterior

56 studies on the registry are indexed under Uveitis, Anterior; 9 are open to participants now.

This study's planned enrollment of 117 is above the median of 50 across 45 interventional studies indexed under Uveitis, Anterior.

Browse Uveitis, Anterior studies →

Lead sponsor

University of California, San Francisco is the lead sponsor of 2,169 studies on the registry; 372 are open to participants now.

Of its 267 completed or terminated interventional studies of FDA-regulated products, 202 (76%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

Trial I - Inclusion Criteria

  • Age at or above the age of majority at the time of enrollment (≥18 years of age in the United States; ≥20 years of age in Thailand and Taiwan)
  • Presenting with active anterior uveitis, defined as ≥1+ anterior chamber cell per -Standardization of Uveitis Nomenclature (SUN) Working Group criteria, in one or both eyes at the time of screening
  • Clinical features suggestive of a viral etiology for anterior uveitis, as determined by the treating study ophthalmologist, including but not limited to one or more of the following:
  • Unilateral hypertensive uveitis (elevated intraocular pressure in the setting of anterior chamber inflammation)
  • Coin-shaped or stellate keratic precipitates
  • Iris atrophy
  • Corneal endothelial changes consistent with CMV endotheliitis
  • Detection of cytomegalovirus (CMV) DNA by directed polymerase chain reaction (PCR) testing of aqueous humor obtained via anterior chamber paracentesis at the screening visit (Exam 0), as determined by local site PCR testing
  • Willingness and ability to provide written prior to enrollment and prior to any research-specific procedures
  • Willingness and ability to comply with study visit schedule, medication regimen, and study procedures for the duration of Trial I (21 days)
  • For participants of :
  • Female participants must agree to use at least one effective method of during the study treatment period and for at least 30 days following the last dose of study medication
  • Male participants with female partners of reproductive potential must agree to use barrier contraception during the study treatment period and for at least 90 days following the last dose of study medication

Trial II - Inclusion Criteria

Participants may enter Trial II via one of two pathways. All participants must meet the following general inclusion criteria:

  • Age at or above the age of majority (≥18 years of age in the United States; ≥20 years of age in Thailand and Taiwan)
  • Prior confirmed diagnosis of CMV anterior uveitis, established by positive PCR testing for CMV DNA in aqueous humor obtained via anterior chamber paracentesis during an active episode of anterior uveitis (uveitis flare). This confirmation may have been established either:
  • During participation in Trial I of the current study, or
  • Prior to enrollment directly into Trial II, in which case documentation of a prior positive aqueous CMV PCR result is required
  • Currently clinically inactive anterior uveitis, defined as ≤0.5+ anterior chamber cell per SUN criteria, sustained for a minimum of 2 weeks prior to enrollment into Trial II
  • Completion of a minimum 2-week free from all antiviral therapy prior to randomization into Trial II
  • Willingness and ability to provide written informed consent for Trial II participation (a separate consent process from Trial I) prior to enrollment and prior to any Trial II-specific research procedures
  • Willingness and ability to comply with the Trial II visit schedule, medication regimen, and study procedures for the duration of the 12-month follow-up period
  • For participants of reproductive potential:
  • Female participants must agree to use at least one effective method of contraception during the study treatment period and for at least 30 days following the last dose of study medication
  • Male participants with female partners of reproductive potential must agree to use barrier contraception during the study treatment period and for at least 90 days following the last dose of study medication

Exclusion criteria

Exclusion Criteria:

Trial I - Exclusion Criteria

  • Inactive anterior uveitis (≤0.5+ anterior chamber cell per SUN criteria) at the time of screening or enrollment
  • Intermediate uveitis, posterior uveitis, or panuveitis as the primary diagnosis, with or without concurrent anterior segment involvement
  • Detection of herpes simplex virus (HSV) or varicella zoster virus (VZV) by directed PCR testing of aqueous humor obtained at the screening paracentesis, regardless of whether CMV is also detected
  • Receipt of any antiviral therapy (systemic or topical ophthalmic) within 14 days prior to the screening visit
  • Receipt of a periocular or intraocular injection within 8 weeks prior to the screening visit
  • Current use of systemic therapy, including but not limited to systemic corticosteroids (at doses exceeding the equivalent of prednisone 10 mg/day), immunomodulatory agents (e.g., methotrexate, mycophenolate mofetil, azathioprine, cyclosporine), or biologic agents
  • Known immunocompromising condition, including but not limited to:
  • (HIV) infection, regardless of or viral load
  • Solid organ or hematopoietic stem cell transplant recipient
  • Active requiring chemotherapy or radiation therapy
  • Primary or acquired immunodeficiency disorder
  • Abnormal screening laboratory values, specifically:
  • (ANC) \< 500 cells/µL
  • count \< 25,000/µL
  • \< 8 g/dL
  • Serum creatinine > 2.5 mg/dL or estimated (eGFR) \< 30 mL/min/1.73 m²
  • (ALT) or aspartate aminotransferase (AST) > 5 times the
  • Pregnancy or breastfeeding at the time of screening or enrollment. A negative pregnancy test is required for all female participants of prior to enrollment.
  • Known or prior serious adverse reaction to ganciclovir, valganciclovir, acyclovir, or any component of the study medications
  • Recent or planned ocular surgery in the study eye within 30 days prior to enrollment or anticipated within the 21-day Trial I study period
  • Known disease that could independently cause anterior uveitis (e.g., HLA-B27-associated uveitis, sarcoidosis, Behçet's disease, juvenile idiopathic arthritis-associated uveitis), unless CMV is confirmed as the causative agent by positive aqueous PCR and the treating ophthalmologist determines that CMV anterior uveitis is the primary diagnosis
  • Inability or unwillingness to comply with study visit schedule, medication regimen, or study procedures
  • Participation in another interventional clinical trial involving an drug or device within 30 days prior to enrollment, or concurrent participation in another interventional clinical trial
  • Any medical, psychological, or social condition that, in the opinion of the principal investigator or site investigator, would compromise the participant's ability to safely participate in the study, adhere to the study protocol, or provide valid

Trial II - Exclusion Criteria

  • Active anterior uveitis at the time of enrollment into Trial II, defined as ≥1+ anterior chamber cell per SUN criteria
  • Failure to achieve a minimum of 2 weeks of clinical inactivity (≤0.5+ anterior chamber cell) prior to enrollment into Trial II
  • Failure to complete a minimum 2-week free from all antiviral therapy prior to randomization into Trial II
  • No documented prior PCR-confirmed diagnosis of CMV anterior uveitis in aqueous humor obtained during an active episode of inflammation (uveitis flare), either during Trial I participation or prior to direct Trial II enrollment
  • Receipt of any antiviral therapy within 14 days prior to the Trial II enrollment visit (i.e., the 2-week washout requirement has not been met)
  • Current use of systemic immunosuppressive therapy, including systemic corticosteroids at doses exceeding the equivalent of prednisone 10 mg/day, immunomodulatory agents, or biologic agents, at the time of Trial II enrollment
  • Known immunocompromising condition as defined in Trial I exclusion criterion 7 above
  • Abnormal laboratory values at the time of Trial II enrollment screening, using the same thresholds as defined in Trial I exclusion criterion 8 above
  • Pregnancy or breastfeeding at the time of Trial II enrollment. A negative pregnancy test is required for all female participants of reproductive potential prior to Trial II randomization.
  • Known hypersensitivity or prior serious adverse reaction to ganciclovir, valganciclovir, acyclovir, or any component of the study medications
  • Recent or planned ocular surgery in the study eye within 30 days prior to Trial II enrollment or anticipated within the first 3 months of the Trial II follow-up period Inability or unwillingness to comply with the Trial II visit schedule, medication regimen, or study procedures for the 12-month follow-up period
  • Participation in another interventional clinical trial involving an investigational drug or device concurrent with Trial II participation, or within 30 days prior to Trial II enrollment
  • Any medical, psychological, or social condition that, in the opinion of the principal investigator or site investigator, would compromise the participant's ability to safely participate in Trial II, adhere to the study protocol, or provide valid informed consent
Terms in these criteria, in plain language(18)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Reproductive potential

Able to have children. For women this usually means from the first period until menopause, unless permanently unable to through surgery; for men, unless permanently sterile. Read who the line is about — participants, women, men, or their partners.

Criteria about it usually ask for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Washout period

A planned gap after a treatment, so that its effects can lessen before the study treatment or a study assessment. Ask the study team and the doctor who prescribed it before changing any medicine.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

CD4 count

The number of CD4 cells, a type of white blood cell, in a given amount of blood. It is used to follow how well the immune system is doing in HIV.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Investigator)
Enrollment
117 participants (estimated)

Study arms

  • Active comparator
    Oral valganciclovir

    Oral valganciclovir 900 mg twice daily.

    Drug: Valganciclovir

  • Active comparator
    Topical ganciclovir 2% eye drop

    Topical ganciclovir instilled into affected eye 6 times daily.

    Drug: Ganciclovir (GCV)

  • Placebo comparator
    Placebo

    This arm does not receive antiviral therapy, but this arm will receive topical corticosteroid eye drop like the other two active arms for inflammation management.

    Drug: Placebo

Interventions

  • Trial I will use oral valganciclovir 450 mg tablet (2 tablets twice daily). Trial II will use oral valganciclovir 450 mg tablet (1 tablet twice daily).

    Also known as: Oral valganciclovir

  • Ganciclovir 2% eye drop (compounded).

    Also known as: Topical ganciclovir eye drops

  • DrugPlacebo

    Placebo tablets and placebo drops.

06

What researchers measure

Primary outcomes

  1. Primary Outcome Measure - Trial I

    Trial I Aqueous Humor CMV Viral Load at Day 7

    Time frame: 7 days

  2. Primary Outcome Measure - Trial II

    Trial II Recurrence of Anterior Uveitis Inflammation Over 12 Months

    Time frame: 12 months

Secondary outcomes

  1. Secondary Outcome Measure - Trial I

    Trial I proportion of patients achieving clinical inactivity of anterior chamber inflammation at Day 7

    Time frame: 7 days

  2. Secondary Outcome Measure Trial I at 21 days

    Trial I Clinical proportion of patients achieving clinical inactivity of anterior chamber Inflammation at Day 21

    Time frame: 21 days

  3. Trial I intraocular pressure at 7 days

    Trial I Intraocular Pressure at Day 7

    Time frame: 7 days

  4. Intraocular pressure at 21 days

    Trial I Intraocular Pressure at Day 21

    Time frame: 21 days

  5. Visual acuity at 7 days

    Trial I Visual Acuity at Day 7

    Time frame: 7 days

  6. Visual acuity at 21 days

    Trial I Visual Acuity at Day 21

    Time frame: 21 days

  7. Topical corticosteroid effect on baseline CMV viral load

    Change in aqueous humor CMV viral load (IU/mL) per additional topical corticosteroid drop used daily at the time of first anterior chamber paracentesis

    Time frame: 7 days

  8. Presence of detectable CMV viral load during recurrence in Trial II

    Trial II Presence of Detectable Aqueous CMV Viral Load at Time of Recurrence

    Time frame: 12 months

Other outcomes

  1. Trial topical ganciclovir 2% vs placebo

    Trial I Topical Ganciclovir 2% Versus Placebo: Post-Treatment CMV Viral Load at Day 7 (Subsidiary Analysis)

    Time frame: 7 days

  2. Prevalence of CMV antiviral resistance mutations in Trial II recurences

    Trial II Prevalence of CMV Mutations Conferring Antiviral Resistance at Time of Recurrence

    Time frame: 12 months

  3. Host transcriptional profiles

    Specific Aim 3 Host Transcriptional Signatures in CMV Anterior Uveitis (Translational)

    Time frame: 12 months

  4. Time to first recurrence during Trial II

    Trial II Time to First Recurrence of Inflammation

    Time frame: 12 months

07

Study locations

6 sites
08

References and documents

Publications

  • Somkijrungroj T, Laovirojjanakul W, Xiong F, et al. Systemic and topical control of active cytomegalovirus anterior uveitis: a randomized-controlled trial. British Journal of Ophthalmology. 2026;in submission
  • Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, Griffiths P. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis. Rev Med Virol. 2019 May;29(3):e2034. doi: 10.1002/rmv.2034. Epub 2019 Jan 31. PubMed 30706584 ↗
  • Chan NS, Chee SP, Caspers L, Bodaghi B. Clinical Features of CMV-Associated Anterior Uveitis. Ocul Immunol Inflamm. 2018;26(1):107-115. doi: 10.1080/09273948.2017.1394471. Epub 2017 Nov 27. PubMed 29172842 ↗
  • Chen X, Li C, Peng X, Lum F, McLeod SD, Acharya NR. Use of Anterior Chamber Paracentesis for Diagnosis in Viral Anterior Uveitis. Ophthalmology. 2024 May;131(5):634-636. doi: 10.1016/j.ophtha.2023.12.034. Epub 2024 Jan 4. No abstract available. PubMed 38184172 ↗
  • Benador-Shen C, Shantha J, Lee J, Qian Y, Doan T, Gonzales JA. Multiple Anterior Chamber Paracenteses May Be Needed to Identify Cytomegalovirus Anterior Uveitis. Am J Ophthalmol. 2025 Jan;269:189-194. doi: 10.1016/j.ajo.2024.08.025. Epub 2024 Aug 31. PubMed 39218387 ↗
  • Bhoopat T, Takhar JS, Oldenburg CE, Keenan JD, Gonzales JA, Margolis TP. Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir. Cornea. 2020 May;39(5):584-589. doi: 10.1097/ICO.0000000000002251. PubMed 32068609 ↗
  • Touhami S, Qu L, Angi M, Bojanova M, Touitou V, Lehoang P, Rozenberg F, Bodaghi B. Cytomegalovirus Anterior Uveitis: Clinical Characteristics and Long-term Outcomes in a French Series. Am J Ophthalmol. 2018 Oct;194:134-142. doi: 10.1016/j.ajo.2018.07.021. Epub 2018 Jul 26. PubMed 30055154 ↗
  • Tranos P, Markomichelakis N, Koronis S, Sidiropoulos G, Tranou M, Rasoglou A, Stavrakas P. CMV-Related Anterior Uveitis in a Mediterranean European Population: Clinical Features, Prognosis, and Long-Term Treatment Outcomes. Ocul Immunol Inflamm. 2024 Nov;32(9):2138-2143. doi: 10.1080/09273948.2024.2329315. Epub 2024 Apr 15. PubMed 38621024 ↗
  • Chronopoulos A, Roquelaure D, Souteyrand G, Seebach JD, Schutz JS, Thumann G. Aqueous humor polymerase chain reaction in uveitis - utility and safety. BMC Ophthalmol. 2016 Oct 28;16(1):189. doi: 10.1186/s12886-016-0369-z. PubMed 27793120 ↗
  • Trivedi D, Denniston AK, Murray PI. Safety profile of anterior chamber paracentesis performed at the slit lamp. Clin Exp Ophthalmol. 2011 Nov;39(8):725-8. doi: 10.1111/j.1442-9071.2011.02565.x. Epub 2011 Apr 27. PubMed 22050560 ↗
  • Sheng Q, Zhai R, Fan X, Kong X. 2% Ganciclovir Eye Drops Control Posner-Schlossman Syndrome Relapses With/Without Cytomegalovirus Intraocular Reactivation. Front Med (Lausanne). 2022 Mar 9;9:848820. doi: 10.3389/fmed.2022.848820. eCollection 2022. PubMed 35355609 ↗
  • Chen PJ, Lin IH, Chi YC, Lai CC, Hung JH, Tseng SH, Huang YH. Long-Term Outcome of Treatment with 2% Topical Ganciclovir Solution in Cytomegalovirus Anterior Uveitis and Corneal Endotheliitis. Infect Drug Resist. 2022 Jun 29;15:3395-3403. doi: 10.2147/IDR.S370905. eCollection 2022. PubMed 35791348 ↗
  • Keorochana N, Choontanom R. Efficacy and safety of an extemporaneous preparation of 2% ganciclovir eye drops in CMV anterior uveitis. BMJ Open Ophthalmol. 2017 Sep 7;2(1):e000061. doi: 10.1136/bmjophth-2016-000061. eCollection 2017. PubMed 29354718 ↗
  • Chee SP, Jap A. Cytomegalovirus anterior uveitis: outcome of treatment. Br J Ophthalmol. 2010 Dec;94(12):1648-52. doi: 10.1136/bjo.2009.167767. Epub 2010 Jun 24. PubMed 20576767 ↗
  • Hsiao YT, Kuo MT, Chiang WY, Chao TL, Kuo HK. Epidemiology and clinical features of viral anterior uveitis in southern Taiwan-diagnosis with polymerase chain reaction. BMC Ophthalmol. 2019 Apr 3;19(1):87. doi: 10.1186/s12886-019-1093-2. PubMed 30943921 ↗
  • Park SW, Yu HG. Association of cytomegalovirus with idiopathic chronic anterior uveitis with ocular hypertension in Korean patients. Ocul Immunol Inflamm. 2013 Jun;21(3):192-6. doi: 10.3109/09273948.2012.754908. Epub 2013 Mar 12. PubMed 23480606 ↗
  • Dunn JP, MacCumber MW, Forman MS, Charache P, Apuzzo L, Jabs DA. Viral sensitivity testing in patients with cytomegalovirus retinitis clinically resistant to foscarnet or ganciclovir. Am J Ophthalmol. 1995 May;119(5):587-96. doi: 10.1016/s0002-9394(14)70217-x. PubMed 7733184 ↗

Individual participant data

Plan to share: No — Individual participant data (IPD) will not be shared beyond the study team and authorized oversight bodies. The study involves sensitive personal health information from participants across international sites in the United States, Thailand, and Taiwan. Sharing IPD raises privacy and confidentiality concerns given variability in data protection regulations across jurisdictions. De-identified aggregate data and results will be made available through peer-reviewed publication and ClinicalTrials.gov results reporting. Requests for de-identified data for secondary research may be considered following primary results publication, subject to IRB approval and a data sharing agreement with the principal investigator.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 11, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07513623
Responsible party
Sponsor
First posted
Apr 7, 2026
Start date
Nov 1, 2026 (estimated)
Primary completion
Dec 31, 2031 (estimated)
Completion
Oct 31, 2032 (estimated)
Last update
Aug 11, 2026

Study contacts

John A Gonzales, MD
Contact
john.gonzales@ucsf.edu
415-476-1442
John A Gonzales, MD
principal investigator · University of California, San Francisco

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is not yet recruiting, as verified in Aug 2026. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Studies of the drugs tested here: Valganciclovir · Ganciclovir

Start the discussion