Outcomes of Infectious Panuveitis Associated with Simultaneous Multi-Positive Ocular Fluid Polymerase Chain Reaction

Abstract

Purpose: To evaluate features of infectious panuveitis associated with multiple pathogens detected by ocular fluid sampling. Methods: Single center, retrospective, consecutive case series of patients with aqueous/vitreous polymerase chain reaction (PCR) testing with > 1 positive result in a single sample from 2001-2021. Results: Of 1,588 PCR samples, 28 (1.76%) were positive for two pathogens. Most common pathogens were cytomegalovirus (CMV) (n=16, 57.1%) and Epstein-Barr virus (EBV) (n=13, 46.4%), followed by varicella zoster virus (n=8, 28.6%), Toxoplasma gondii (n=6, 21.4%) herpes simplex virus-2 (n=6, 21.4%), herpes simplex virus-1 (n=6, 21.4%), and Toxocara (n=1, 3.6%). Mean initial and final visual acuity (VA) (logMAR) were 1.3 ± 0.9 (Snellen ∼ 20/400) and 1.3 ± 1.1 (Snellen ∼ 20/400), respectively. CMV-positive eyes (n=16, 61.5%) had a mean final VA of 0.94 ± 1.1 (Snellen∼20/175) whereas CMV-negative eyes (n=10, 38%) had a final VA of 1.82 ± 1.0 (Snellen ∼20/1320) (p<0.05). Main clinical features included intraocular inflammation (100%), retinal whitening (84.6%), immunosuppression (65.4%), retinal hemorrhage (38.5%), and retinal detachment (34.6%). Conclusion: CMV or EBV were common unique pathogens identified in multi-PCR positive samples. Most patients with co-infection were immunosuppressed with a high rate of retinal detachment and poor final VA. CMV-positive eyes had better visual outcomes compared to CMV-negative eyes.