Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses
that are well-known agents of keratitis, anterior uveitis, scleritis and
retinitis. CMV is usually associated with ocular diseases in immunosuppressed
individuals, with a notable exception of hypertensive anterior uveitis with
distinctive clinical features in immunocompetent patients. This syndrome was
characterized in the last two decades in Europe and Southeast Asia, and then
documented in the rest of world. Definitive diagnosis in these cases is usually
made by Polymerase Chain Reaction (PCR) of the anterior chamber fluid. We report
three immunocompetent Brazilian adults with history of multiple
glaucomatocyclitic crises and presenting with chronic hypertensive anterior
uveitis invariably with mild anterior chamber inflammation and characteristic
scarce nummular keratic precipitates. CMV DNA was successfully amplified and
detected in the aqueous humor of all patients. Corneal endothelial counts were
significantly reduced in the involved eyes, with one patient developing bullous
keratopathy. All patients were then treated with topical ganciclovir gel and
corticosteroids, with subsequent control of the intraocular inflammation. CMV
may represent an overlooked / underestimated etiology of hypertensive anterior
uveitis that may progressively lead to endothelial dysfunction, culminating in
bullous keratopathy. Management of patients is challenging, with the potential
use of topical antivirals to decrease the number of relapses, and
corticosteroids to control anterior uveitis / endotheliitis and to protect the
corneal endothelium.
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