Clinical Manifestations of Cytomegalovirus-Associated Posterior Uveitis and Panuveitis in Patients Without Human Immunodeficiency Virus Infection (original) (raw)
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Cytomegalovirus anterior uveitis: long-term follow-up of immunocompetent patients
Graefe's Archive for Clinical and Experimental Ophthalmology, 2014
Background We aimed to report on the clinical findings and long-term prognosis of patients with cytomegalovirus (CMV) anterior uveitis. Methods This was a retrospective observational study on 15 immunocompetent patients with CMV anterior uveitis and a follow-up longer than 24 months (mean: 62.1±28.5 months). Results Uveitis was unilateral and hypertensive in all cases, with acute relapsing having the characteristics of Posner-Schlossman syndrome in nine (60 %) and chronic in nine patients (40 %), three of whom were clinically classified as Fuchs' heterocromic iridocyclitis (20 %). All patients received topical antiviral and corticosteroid therapy, with six patients also receiving systemic therapy with valganciclovir or acyclovir. The mean number of uveitis relapses significantly decreased, before and after anti-CMV therapy, from 0.23±0.17 to 0.03± 0.03 (p<0.001), without significant differences among patients treated with topical therapy alone or combined topical and systemic therapy. Cataracts developed in nine out of 13 patients (69.2 %). A chronic raise in intraocular pressure (IOP) was found in 13 patients (86.6 %), with nine requiring surgery (60 %). At the end of the follow-up, all patients had a quiescent uveitis, with ten of them requiring topical low dose steroid therapy (66.6 %) and combined with systemic acyclovir in four cases. Eight patients (53.3 %) were on antiglaucomatous therapy. The last mean IOP value was 14.9±3.6 mmHg (range 8-21 mmHg), and visual acuity was 0.89±0.21. Conclusions CMV-associated anterior uveitis has a fairly good long-term visual prognosis. Antiviral therapy can reduce the frequency of relapses, but cataracts and a chronic raise in IOP are frequent complications often requiring a surgical approach.
Ocular manifestations of cytomegalovirus in immunocompetent hosts
Current opinion in ophthalmology, 2018
This review highlights recent studies that have increasingly implicated cytomegalovirus (CMV) as a significant cause of keratouveitis and retinitis in immunocompetent hosts. Molecular testing has identified that CMV infection is frequently present in cases of Posner-Schlossman and Fuchs, keratouveitis syndromes previously presumed to be idiopathic conditions. Ocular hypertension and endothelial cell loss are important complications of CMV keratouveitis and are likely mediated by viral invasion of the trabecular meshwork and corneal endothelium. Topical ganciclovir is a well tolerated, effective, and economical therapy. CMV retinitis is possible in the absence of HIV/AIDS. CMV has long been considered an innocuous infection in the general population, though recent studies have found otherwise. Intraocular reactivation, replication, and invasion of the trabecular meshwork and endothelium lead to recurrent bouts of ocular hypertension and endothelial cell loss, the complications of whi...
Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers
Ocular Immunology and Inflammation
Purpose: To evaluate diagnostic methods and clinical signs of CMV anterior uveitis (AU), a rarely described entity in Europe. Methods: We included patients with clinical characteristics of CMV AU and positive PCR and/or Goldmann-Witmer coefficient (GWc) for CMV. Results: We report 21 patients with unilateral uveitis (100%) and signs of Posner-Schlossman syndrome (PSS) (n = 20, 95.2%), Fuchs uveitis syndrome (FUS) (n = 1, 4.7%), and endotheliitis (n = 4, 19,04%). PCR was positive in 15/21 (71.4%) and GWc in 8/9 patients (88.9%) in aqueous for CMV. GWc was the only positive test in 6/9 patients (66,6%). When PCR alone was performed (without GWc) in the first tap, repeated aqueous taps were needed, twice in five cases and thrice in one case. Conclusion: Combining PCR and GWc were very helpful to confirm the clinical diagnosis of CMV AU. In case of very high clinical suspicion and negative results, repeated tap seems to be recommended.
Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy
Ophthalmology, 2002
To report two cases of recurrent anterior uveitis with sectoral iris atrophy and ocular hypertension during attacks caused by cytomegalovirus (CMV). Two observational case reports. Two immunocompetent patients with a history of recurrent unilateral hypertensive anterior uveitis with sectoral iris atrophy were referred to us with the presumptive diagnosis of herpetic uveitis. Comprehensive ophthalmic examination, aqueous humor polymerase chain reaction (PCR), and peripheral blood serologic studies were performed on both patients. Examination of aqueous humor by PCR was positive for CMV and negative for herpesvirus. Serum IgG/IgM titers disclosed past CMV infection. Both patients responded well to antiviral therapy with ganciclovir. The final visual acuity level was 20/20 in both eyes of both patients. CMV infection can produce recurrent attacks of anterior uveitis with clinical characteristics indistinguishable from those previously considered highly suggestive or even pathognomonic for herpetic infection. This observation has implications for the therapeutic management of such patients.
An Unusual Cytomegalovirus Ocular Manifestation in a Non-HIV Patient
Cureus, 2022
Ng Ming Choo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Detection of cytomegalovirus in vitreous, aqueous and conjunctiva by polymerase chain reaction (PCR)
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on vitreous, aqueous and conjunctiva for the detection of cytomegalovirus in AIDS patients with a clinical diagnosis of cytomegalovirus retinitis. PCR-based assay was used to detect cytomegalovirus DNA in vitreous, aqueous and conjunctival samples from 24 patients with the acquired immunodeficiency syndrome (AIDS) who had untreated clinically diagnosed cytomegalovirus retinitis and from 15 immunocompetent patients, including 11 with retinal detachment, 2 with macular hole and 2 with vitreous hemorrhage. Cytomegalovirus DNA was detected in 16, 9 and 3 of 24 vitreous, aqueous and conjunctival samples, respectively, from patients with AIDS, untreated clinically diagnosis of cytomegalovirus retinitis; and in one patient out of 15 vitreous, aqueous and conjunctival samples from immunocompetent patients with vitreoretinal diseases. The use of PCR in the detection of cytomegalovirus in vitreous, aqueous and conju...
American Journal of Ophthalmology, 2003
PURPOSE: To determine the association between anticytomegalovirus (CMV) maintenance therapy after immune recovery and immune recovery uveitis in acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART). • DESIGN: Observational cohort study. • METHODS: Data were obtained on AIDS patients with CMV retinitis followed up at the AIDS Ocular Research Unit of University of California San Diego from November 1995 to October 1999. Immune recovery was defined as CD4 count greater than 50 cells/l for more than 3 months. Patients with immune recovery uveitis presented with vitritis, cystoid macular edema, or epiretinal membrane. Statistical analyses were conducted to determine the risk of continued use of anti-CMV therapy after immune recovery and the relationship of developing immune recovery uveitis with the type of anti-CMV therapy. • RESULTS: Forty-three patients (64 eyes) had healed CMV retinitis and had achieved immune recovery. Thirty-one patients (48 eyes) received anti-CMV therapy after immune recovery, and 20 patients (29 eyes) developed immune recovery uveitis. Per-eye analyses revealed a 3.8-fold increase in the odds of developing immune recovery uveitis with anti-CMV therapy compared with no treatment (P ؍ .02). If treated with cidofovir the odds were 3.3 greater than if treated with an alternative regimen (P ؍ .04), 4.1 greater if treated intravenously (P ؍ .01), and 5.2 greater than if not treated (P ؍ .004). If not treated with cidofovir, a nonsignificant increase in the risk (2.4) of immune recovery uveitis was found (P ؍ .15). Neither the potency nor the use of implants for noncidofovir treatment was related to the risk of recovery uveitis (P > .62). • CONCLUSIONS: The use of cidofovir is a primary risk factor in the subsequent development of immune recovery uveitis. Ongoing treatment of healed CMV retinitis after immune recovery does not appear to protect against the development of immune recovery uveitis. (Am J Ophthalmol 2003;136:696 -702.