Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis

Abstract

Aim: To describe the diagnostic and therapeutic management of cytomegalovirus (CMV) anterior uveitis unassociated with retinal necrosis in immunocompetent patients. Methods: Patients referred between 2001 and 2003 for management of unilateral, chronic, recurrent uveitis associated with secondary glaucoma underwent extensive investigation including laboratory tests for herpes virus infections. Specific antiviral treatment was initiated in all cases and the level of ocular inflammation was evaluated during the follow up. Results: Five patients, three men and two women, were included. Median age was 50 years old (range 30-80 years). Anterior unilateral uveitis without iris atrophy was observed in all cases. Uveitis was chronic in three cases and recurrent in two cases. Glaucoma was observed in all patients with a median intraocular pressure of 30 mm Hg (range 22-43 mm Hg). Five patients responded initially to specific anti-CMV therapy. Even though glaucoma surgery was necessary in two cases, both ocular inflammation and glaucoma were controlled in all cases. Relapses occurred in three cases after cessation of therapy, requiring prolonged maintenance therapy with valganciclovir. Conclusions: CMV infection and specific antiviral therapy should be considered in all cases of relapsing or chronic iridocyclitis and secondary glaucoma. Maintenance regimens of valganciclovir may be necessary to prevent further relapses.

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

“…The third step consists of the elongation step (Elongation) in which Taq polymerase (or another DNA polymerase) has its optimum activity temperature at around 72°C. The last step is the final elongation: the amplified target can be obtained after [30][31][32][33][34][35][36][37][38][39][40] However, multiplex PCR or any other qualitative PCR techniques cannot quantitatively measure copy number of genomic DNA. Given the extremely high sensitivity of PCR, positive results from qualitative PCR techniques can be false positives due to contamination.…”

“…A new era of uveitis: impact of polymerase chain reaction in intraocular inflammatory diseases 5 Corneal endotheliitis and iritis [26] Acute retinal necrosis [27], [11] HHV2 (HSV2) Acute retinal necrosis [43], [27], [11] HHV3 (varicella-zoster virus; VZV) Herpes zoster ophthalmicus/zoster sine herpete [31], [40] Acute retinal necrosis [28], [27], [11] HHV4 (Epstein-Barr virus; EBV) Anterior uveitis/pan-uveitis [55], [54], [53] Acute retinal necrosis [11] Intraocular lymphoma [56] HHV5 (cytomegalovirus; CMV Corneal endotheliitis [36], [35], [7], [37] Iritis (uveitis) [33], [6], [34] Cytomegalovirus retinitis [32] HHV6 Iritis (uveitis) [59], [61], [60] Endophthalmitis [60] Keratitis [61], [63], [60], [62] AIDS-associated retinitis [64] HHV7 Corneal endotheliitis and iritis [66] HHV8 Corneal endotheliitis and iritis [67] Kaposi's sarcoma (conjunctiva, ocular adnexa) [70] HHV1-8 Eight types of human herpes virus, AIDS acquired immune deficiency syndrome a These are representative references by PCR-associated papers…”

“…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).…”

“…However, CMV-AU always has a small proportion of cells in the anterior chamber with or without corneal endotheliitis; other features of CMV-AU are diffuse iris atrophy, episodes of high intraocular pressure (IOP), and no involvement of the posterior segment of the eye [6,[33][34][35]. These ocular manifestations of CMV-AU are similar to those of Posner-Schlossman syndrome and Fuchs heterochromic iridocyclitis.…”

“…The 2009 prospective survey enrolled a total of 3830 patients who were newly diagnosed with uveitis over a 1-year period at 36 university hospitals. Of these patients, 33.5% had unclassified or idiopathic uveitis and 66.5% were identified with specific etiologies consisting of non-infectious diseases (50.1%) and infectious diseases (16.4%). The leading etiology of uveitis was sarcoidosis (10.6%) followed by Vogt-Koyanagi-Harada disease (7.0%), acute anterior uveitis (AAU) (6.5%) including HLA-B27-positive AAU (1.9%), scleritis with or without uveitis (6.1%), herpetic iritis (4.2%), Behcet's disease (3.9%), bacterial endophthalmitis (2.5%), and masquerade syndrome (2.5%) including intraocular lymphoma (1.3%).…”