Comparison of the ocular characteristics of anterior uveitis caused by herpes simplex virus, varicella-zoster virus, and cytomegalovirus

Takase, Hiroshi; Kubono, Reo; Terada, Yukiko; Imai, Ayano; Fukuda, Shoko; Tomita, Makoto; Miyanaga, Masaru; Kamoi, Koju; Sugita, Sunao; Miyata, Kazunori; Mochizuki, Manabu

doi:10.1007/s10384-014-0340-6

Cited by 91 publications

(98 citation statements)

References 16 publications

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“…5 In addition, when there is an active anterior uveitis with at least 1+ anterior chamber cell that is suspected to be viral in etiology (particularly in association with stellate keratic precipitates, elevated intraocular pressure, or iris transillumination defects), anterior chamber paracentesis may be considered with directed polymerase chain reaction for HSV, varicella-zoster virus, and cytomegalovirus. 6 In our case with mild anterior chamber cell (less than 1+), there was complete resolution with an oral antiviral and topical steroid.…”

Section: Discussionmentioning

confidence: 92%

Unilateral Posterior Interstitial Keratitis as a Clinical Presentation of Herpes Simplex Virus Disease

Farooq

Paley

Lubniewski

et al. 2017

Cornea

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Purpose: To describe a case series of patients with unilateral, posterior interstitial keratitis presumed to be caused by herpes simplex virus.Methods: Retrospective case series.Results: Five patients were found to have unilateral, posterior interstitial keratitis. Three of the involved eyes had decreased corneal sensation, and 2 eyes had corneal stromal neovascularization. All patients were treated with topical steroids and an oral antiviral, and among those with long-term follow-up, clinical improvement required treatment over an extended duration. A review of the literature revealed 1 reported case with a similar clinical appearance, although that case was attributed to Lyme disease. Conclusions:The clinical presentation of unilateral, posterior interstitial keratitis may be rare manifestation of herpes simplex virus keratitis.

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Section: Discussionmentioning

confidence: 92%

Unilateral Posterior Interstitial Keratitis as a Clinical Presentation of Herpes Simplex Virus Disease

Farooq

Paley

Lubniewski

et al. 2017

Cornea

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“…Genomic DNA of HSV [24][25][26][27], VZV [25,[28][29][30][31], and CMV [6,7,25,[32][33][34][35][36][37][38] has been detected by PCR in the aqueous humor of certain types of AU, corneal endotheliitis, and posterior uveitis with necrotizing retinitis (ARN and CMV retinitis).…”

Section: Hsv1 Hsv2 Vzv and CMVmentioning

confidence: 99%

“…According to various authors [6,25], HSV1-AU, VZV-AU, and CMV-AU share the following clinical features: (1) occurrence in immunocompetent patients; (2) unilateral involvement; (3) relatively acute process; (4) presence of large KPs; (5) episodes of high IOP. However, there are a number of differences in their clinical presentations.…”

Section: Hsv1 Hsv2 Vzv and CMVmentioning

confidence: 99%

A new era of uveitis: impact of polymerase chain reaction in intraocular inflammatory diseases

et al. 2016

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Uveitis is a sight-threatening intraocular inflammatory disorder which may occur from both infectious and non-infectious or autoimmune causes. The frequency of infectious uveitis and autoimmune uveitis varies depending on countries and regions. According to a nationwide survey conducted by the Japanese Ocular Inflammation Society, infectious and non-infectious uveitis accounted for 16.4 and 50.1% of new patients, respectively while the remaining 33.5% of new uveitis cases were not classified or were idiopathic uveitis. Infectious uveitis is particularly important because it causes tissue damage to the eye and may result in blindness unless treated. However, it can be treated if the pathogenic microorganisms are identified promptly and accurately. Remarkable advancements in molecular and immunological technologies have been made in the last decade, and the diagnosis of infectious uveitis has been greatly improved by the application of molecular and immunological investigations, particularly polymerase chain reaction (PCR). PCR performed on a small amount of ocular samples provides a prompt, sensitive, and specific molecular diagnosis of pathogenic microorganisms in the eye. This technology has opened a new era in the diagnosis and treatment of uveitis, enabling physicians to establish new clinical entities of uveitis caused by infectious microorganisms, identify pathogens in the eyes of many patients with uveitis, and determine prompt diagnosis and appropriate therapy. Here we review the PCR process, new PCR tests specialized for ocular diseases, microorganisms detected by the PCR tests, diseases in the eye caused by these microorganisms, and the clinical characteristics, diagnosis, and therapy of uveitis.

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“…Although infectious and neoplastic causes exist, the majority of cases are presumed to be immune in origin, and this is reflected in the high prevalence of systemic disease among patients with AAU [2•, 3]. However, there are similarities as well as distinct differences in the patterns of uveitis in the various regions of the world because of geographical, environmental, and genetic differences [4][5][6][7][8].There are many recent advances in the field of immunopathology, and several immunological pathways are now known to be involved in the development of uveitis. It may be caused by several mechanisms, such as infectious, inflammatory (no obvious infection), autoimmune, or idiopathic [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 98%

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

2015

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Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are HLA-B27 positive, should be questioned about inflammatory low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye inflammation responds well to corticosteroid and mydriatic eye drops and without the need for additional therapy. Use of oral corticosteroids is reserved for patients, especially with associated chronic inflammatory bowel disease or psoriatic arthritis presenting with bilateral, chronic, anterior, and/or intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel therapies, including the use of tumor necrosis factor blockers.

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Comparison of the ocular characteristics of anterior uveitis caused by herpes simplex virus, varicella-zoster virus, and cytomegalovirus

Abstract: Although the AU caused by each of the three types of herpes viruses has a number of common features, each disease also has distinct features that should facilitate an accurate diagnosis.

Cited by 91 publications

References 16 publications

Unilateral Posterior Interstitial Keratitis as a Clinical Presentation of Herpes Simplex Virus Disease

Unilateral Posterior Interstitial Keratitis as a Clinical Presentation of Herpes Simplex Virus Disease

A new era of uveitis: impact of polymerase chain reaction in intraocular inflammatory diseases

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

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