The Diagnostic Utility of Anterior Chamber Paracentesis With Polymerase Chain Reaction in Anterior Uveitis

Anwar, Zane; Galor, Anat; Albini, Thomas A.; Miller, Darlene; Pérez, Víctor L.; Davis, Janet L.

doi:10.1016/j.ajo.2012.12.008

Cited by 69 publications

(39 citation statements)

References 20 publications

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“…Aqueous PCR analysis in uveitis has been previously reported [5–7, 15, 18, 19]. Harper et al reported a 20 % change in the management of patients with posterior uveitis following PCR results [6] and Rothova et al reported foreign DNA in 29 % of posterior uveitis patients with a change in management in 24 %.…”

Section: Discussionmentioning

confidence: 99%

“…However, aqueous humor PCR analysis is not routine and remains controversial because of a low proportion of therapeutic change based on the PCR results in some studies, invasiveness of paracentesis bearing potential complications, and false negatives and positives [5–7]. On these grounds recent reports even question its utility and discourage its practice in anterior uveitis [5, 8]. Recent reports discourage aqueous PCR for the diagnosis of infectious uveitis or favour PCR of vitreous over aqueous [5, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…On these grounds recent reports even question its utility and discourage its practice in anterior uveitis [5, 8]. Recent reports discourage aqueous PCR for the diagnosis of infectious uveitis or favour PCR of vitreous over aqueous [5, 9, 10]. …”

Section: Introductionmentioning

confidence: 99%

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Aqueous humor polymerase chain reaction in uveitis – utility and safety

et al. 2016

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BackgroundTo study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis.MethodsRecords of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity,ResultsThe overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae.ConclusionAqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aqueous humor polymerase chain reaction in uveitis – utility and safety

et al. 2016

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“…The utility of anterior chamber tap has been questioned recently in cases with anterior uveitis 9. However, since the treatment of CMV endotheliitis is very expensive, empirical therapy with oral valgancicovir was not considered.…”

Section: Discussionmentioning

confidence: 99%

Eighteen months of anterior chamber inflammation

2013

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A 60-year-old Chinese patient was seen multiple times in the ophthalmology outpatient department due to persistent anterior-chamber inflammation and raised intraocular pressure. The patient was being treated with topical corticosteroids and oral acyclovir. Signs of corneal endotheliitis were observed in subsequent follow-ups. A clinical diagnosis could be made on slit-lamp examination, but aetiology could not be specified. An anterior-chamber diagnostic tap performed 18 months after the initial presentation revealed cytomegalovirus (CMV). Prompt response was noted with oral valganciclovir treatment. Our case highlights the importance of performing anterior-chamber tap in cases with persistent anterior-chamber inflammation. There was a long interval between the presentation and diagnosis mainly due to the absence of any concurrent ocular signs. An anterior-chamber tap was delayed until the ocular signs were suggestive of CMV endotheliitis. Timely diagnosis in such cases can improve the outcome as well as the prognosis.

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“…While HSV and VZV infections occur worldwide without a racial predilection, CMV uveitis has predominantly been reported among the Chinese and Japanese 19–21. Chee et al from Singapore reported on eyes with hypertensive anterior uveitis and found that the majority was positive for CMV (88.5%) or HSV but not for VZV on aqueous polymerase chain reaction (PCR) analysis 21.…”

Section: Herpes Virus-associated Anterior Uveitismentioning

confidence: 99%

Current aspects on the management of viral uveitis in immunocompetent individuals

Pleyer

Chee

2015

OPTH

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Viruses are a fundamental etiology of ocular inflammation, which may affect all structures of the organ. Advances in molecular diagnostics reveal an increasingly broader spectrum of virus-associated intraocular inflammation, including all members of the herpes family, rubella virus, and other more rare causes such as Epstein–Barr and chikungunya virus. In particular, viruses of the herpes family are important causes of anterior and posterior uveitis. Owing to their often fulminant clinical course and persistence in ocular tissues, a clear differential diagnosis between alpha- and beta-type herpes viruses is essential to guide acute and long-term treatment. Here, we review the epidemiology, clinical, and laboratory findings of virus-associated uveitis with emphasis on their therapy and management and include our own experience.

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The Diagnostic Utility of Anterior Chamber Paracentesis With Polymerase Chain Reaction in Anterior Uveitis

Cited by 69 publications

References 20 publications

Aqueous humor polymerase chain reaction in uveitis – utility and safety

Aqueous humor polymerase chain reaction in uveitis – utility and safety

Eighteen months of anterior chamber inflammation

Current aspects on the management of viral uveitis in immunocompetent individuals

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