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Feng Y, Garcia R, Rojas-Carabali W, Cifuentes-González C, Putera I, Li J, La Distia Nora R, Mahendradas P, Gupta V, de-la-Torre A, Agrawal R. Viral Anterior Uveitis: A Practical and Comprehensive Review of Diagnosis and Treatment. Ocul Immunol Inflamm 2024; 32:1804-1818. [PMID: 37862684 DOI: 10.1080/09273948.2023.2271077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
Anterior uveitis is the most common type of uveitis worldwide. The etiologies of anterior uveitis can be divided into infectious and non-infectious (idiopathic, autoimmune, autoinflammatory, trauma, and others). The viral pathogens most commonly associated with infectious anterior uveitis include Herpes Simplex Virus, Varicella-Zoster Virus, Cytomegalovirus, and Rubella Virus. Other emerging causes of viral anterior uveitis are West Nile Virus, Human-Immunodeficiency Virus, Epstein-Barr Virus, Parechovirus, Dengue Virus, Chikungunya Virus, and Human Herpesvirus type 6,7, and 8. Early recognition allows prompt management and mitigates its potential ocular complications. This article provides an updated literature review of the epidemiology, clinical manifestations, diagnostic tools, and treatment options for viral anterior uveitis.
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Affiliation(s)
- Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Eye Center, Peking University Third Hospital, Beijing, China
| | - Ruby Garcia
- Reno School of Medicine, University of Nevada, Reno, Nebraska, USA
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jingyi Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Eye Center, Peking University Third Hospital, Beijing, China
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | | | - Vishali Gupta
- Advanced Eye Centre, Post- Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Dheyab AM, Albloushi AF, Al-Zuabi A, AlTariqi SM, Tobaigy MF, Al Fawaz A, Abu El-Asrar A. Authors' Reply to Letter to the Editor- in Response to: Comment on Dheyab AM et al. "Long-Term Efficacy of Oral Valganciclovir in Presumed Cytomegalovirus Unilateral Hypertensive Anterior Uveitis". Ocul Immunol Inflamm 2024:1-2. [PMID: 39145883 DOI: 10.1080/09273948.2024.2389246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Abstract
The clinical diagnosis of presumed cytomegalovirus hypertensive anterior uveitis was based on the following criteria: 1) Recurrent episodes of unilateral hypertensive anterior uveitis characterized by acute elevation of intraocular pressure, a few medium-sized or mutton-fat keratic precipitates and mild anterior chamber reaction. These findings might be associated with corneal endotheliitis and iris atrophy. 2) Posterior synechiae and vitreous involvement are typically absent. 3) Intact corneal sensation.
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Affiliation(s)
- Abdulsalam M Dheyab
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman F Albloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asma Al-Zuabi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman M AlTariqi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohannad F Tobaigy
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Al Fawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Caplash S, Paez-Escamilla M, Westcott M, Dansingani KK, Indermill C, Kisma N, Frau E, Sahel JA, Bodaghi B, Jhanji V, Errera MH. Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist. J Ophthalmic Inflamm Infect 2024; 14:14. [PMID: 38594487 PMCID: PMC11004105 DOI: 10.1186/s12348-024-00396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. BODY: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. CONCLUSIONS We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mark Westcott
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nacima Kisma
- Universite Libre de Bruxelles, Hopital Universitaire de Bruxelles, 808 route de Lennik 1170, Bruxelles, Belgium
| | - Eric Frau
- Department of Ophthalmology, Centre hospitalier National des Quinze-Vingts, Paris, France
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013, Paris, France
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Yoo WS, Kwon LH, Eom Y, Thng ZX, Or C, Nguyen QD, Kim SJ. Cytomegalovirus Corneal Endotheliitis: A Comprehensive Review. Ocul Immunol Inflamm 2024:1-10. [PMID: 38417101 DOI: 10.1080/09273948.2024.2320704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024]
Abstract
Cytomegalovirus (CMV) anterior uveitis and corneal endotheliitis are the most common ocular diseases caused by CMV infections in immunocompetent patients. The incidence of CMV corneal endotheliitis is relatively high in middle-aged men. CMV corneal endotheliitis presents with mild anterior chamber inflammation, corneal edema, keratic precipitates, and elevated intraocular pressure. It resembles Posner-Schlossman syndrome and Fuchs uveitis because of the elevated intraocular pressure. Without proper diagnosis and treatment, it may progress to bullous keratopathy or glaucoma, necessitating keratoplasty or glaucoma surgery. Therefore, early diagnosis and treatment are important for a good prognosis. Aqueous humor analysis can facilitate the diagnosis of CMV corneal endotheliitis, and early antiviral treatment can decrease the risk of corneal compensation or glaucomatous optic atrophy. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of CMV corneal endotheliitis along with the evidence for early clinical diagnosis and active antiviral treatment.
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Affiliation(s)
- Woong-Sun Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lee-Ha Kwon
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Zheng Xian Thng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis. Eye (Lond) 2024; 38:61-67. [PMID: 37419957 PMCID: PMC10764303 DOI: 10.1038/s41433-023-02630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. METHODS A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. RESULTS Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. CONCLUSIONS Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.
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Affiliation(s)
- Zheng Xian Thng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Kevin Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Westcott
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew D Dick
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
- UCL Institute of Ophthalmology, London, UK
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, and Schepens Eye Research Institute, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l'Hopital, 75013, Paris, France
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talin Barisani-Asenbauer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marc D de Smet
- Department of Ophthalmology, Leiden University, Leiden, The Netherlands
- MIOS sa, Lausanne, Switzerland
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldstein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James T Rosenbaum
- Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Chiang WY, Lin CP, Cho WH, Yang CH, Chen SN, Hwang YS, Hsu SM, Hwang DK, Chen SC, Kuo HK, Sheu SJ. Cytomegalovirus Uveitis: Taiwan expert consensus. J Formos Med Assoc 2023; 122:668-674. [PMID: 37003913 DOI: 10.1016/j.jfma.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Cytomegalovirus (CMV) uveitis, a type of herpetic uveitis, is a major cause of infectious uveitis. Anterior and posterior CMV uveitis have diverse clinical presentations and treatment modalities. Based on expert consensus in Taiwan, this article provides suggestions regarding clinical manifestations, diagnosis, and treatment strategies for CMV uveitis based on clinical practice experience in Taiwan. CMV uveitis may have a distinct clinical presentation. Polymerase chain reaction (PCR) is an essential diagnostic tool to confirm a diagnosis. Antiviral therapy is the mainstay of treatment. Different agents, routes, and other supplemental treatments have been summarized and discussed in this article. Early diagnosis and appropriate treatment of CMV uveitis are crucial to avoid irreversible complications and vision loss. This consensus provides practical guidelines for ophthalmologists in Taiwan.
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Affiliation(s)
- Wei-Yu Chiang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Hua Cho
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Yih-Shiou Hwang
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chou Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan.
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Cytomegalovirus Anterior Uveitis in an Immunocompetent Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Zhang J, Kamoi K, Zong Y, Yang M, Ohno-Matsui K. Cytomegalovirus Anterior Uveitis: Clinical Manifestations, Diagnosis, Treatment, and Immunological Mechanisms. Viruses 2023; 15:185. [PMID: 36680225 PMCID: PMC9867175 DOI: 10.3390/v15010185] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
Little is known regarding anterior uveitis (AU), the most common ocular disease associated with cytomegalovirus (CMV) infection in immunocompetent populations. CMV AU is highly prevalent in Asia, with a higher incidence in men. Clinically, it manifests mainly as anterior chamber inflammation and elevated intraocular pressure (IOP). Acute CMV AU may resemble Posner-Schlossman syndrome with its recurrent hypertensive iritis, while chronic CMV AU may resemble Fuchs uveitis because of its elevated IOP. Without prompt treatment, it may progress to glaucoma; therefore, early diagnosis is critical to prognosis. Knowledge regarding clinical features and aqueous humor analyses can facilitate accurate diagnoses; so, we compared and summarized these aspects. Early antiviral treatment reduces the risk of a glaucoma surgery requirement, and therapeutic effects vary based on drug delivery. Both oral valganciclovir and topical ganciclovir can produce positive clinical outcomes, and higher concentration and frequency are beneficial in chronic CMV retinitis. An extended antiviral course could prevent relapses, but should be limited to 6 months to prevent drug resistance and side effects. In this review, we have systematically summarized the pathogenesis, clinical features, diagnostic and therapeutic aspects, and immunological mechanisms of CMV AU with the goal of providing a theoretical foundation for early clinical diagnosis and treatment.
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Affiliation(s)
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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Okazawa R, Iwai S, Nagura K, Sora D, Sato T, Takayama K, Harimoto K, Kanda T, Takeuchi M. Epidemiology and characteristics of common forms of anterior uveitis at initial presentation in a tertiary facility in Japan. Jpn J Ophthalmol 2023; 67:22-31. [PMID: 36346554 DOI: 10.1007/s10384-022-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To elucidate detailed epidemiological profile of common types of anterior uveitis (AU) in real-world clinical setting of a tertiary facility in Japan, and to evaluate the characteristic clinical findings at initial presentation. STUDY DESIGN Retrospective cohort study. METHODS Clinical charts of 275 patients (335 eyes) aged 52.5 ± 19.1 years were reviewed retrospectively. Herpetic AU was diagnosed by multiplex polymerase chain reaction tests using aqueous humor. Time of uveitis onset, gender, laterality, disease course since the initial onset of AU, visual acuity (VA) and intraocular pressure (IOP) at first visit, and definitive diagnosis were collected from clinical charts. RESULTS Acute AU (AAU) was the most common (21.8%) form of AU; followed by herpetic AU (20.7%) comprising Herpes Simplex Virus (HSV) (8.0%), Varicella Zoster Virus (VZV) (9.1%) and cytomegalo virus (CMV) (3.6%); scleritis (13.5%); diabetic iritis (7.6%), and Posner-Schlossman syndrome (5.5%). Unilateral AU constituted 78.2%, and VA less than 20/30 accounted for 31.2%. Of all the eyes, 16.1% had an IOP higher than 20 mmHg, out of which 37.0% had herpetic AU, followed by scleritis in 25.9%, and Posner-Schlossman syndrome (PSS) in 11.1%. AU patients over 60 years of age were 40.4%, in which 34.2% had herpetic AU, followed by scleritis in 14.4% and AAU in 13.5%. Herpetic AU patients were significantly older and had higher IOP compared with AAU patients. CONCLUSION The most frequent AU was AAU, followed by herpetic AU. Herpetic AU patients were older and had higher intraocular pressure than AAU patients, although VA was equally impaired in both groups.
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Affiliation(s)
- Rina Okazawa
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Seima Iwai
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Koichi Nagura
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Daisuke Sora
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Kei Takayama
- Sakura street Takayama Eye Clinic, 4-262-1 Sakuragaoka, Higashiyamato, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan.
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10
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Kam KW, Wong CH, Ho M, Sze RKH, Chan PKS, Young AL. Iris Depigmentation in the Prediction of Cytomegalovirus Anterior Uveitis. Ocul Immunol Inflamm 2022; 30:1775-1780. [PMID: 34283680 DOI: 10.1080/09273948.2021.1952277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We hypothesize that the presence of iris depigmentation is associated with the prediction of cytomegalovirus (CMV) as the etiology of chronic or recurrent anterior uveitis. METHODS A prospective cohort study on patients with recurrent or chronic anterior uveitis. Pre-operative data on iris depigmentation and corneal endothelial cell densities were compared between eyes with and without CMV. RESULTS Forty-one eyes of 38 subjects with a mean age of 61.1 ± 11.2 years old were recruited. Seventeen eyes were positive for CMV. A greater proportion of eyes with CMV showed severe or diffuse iris depigmentation than eyes without CMV, and possessed larger corneal endothelial cells (p = .028). When severe iris depigmentation was present with a reduced endothelial cell density, the positive and negative predictive values were raised to 100.0% and 64.9% from 41.5% and 58.5%, respectively. CONCLUSION Iris depigmentation is a potential clinical biomarker in predicting CMV in chronic or recurrent anterior uveitis.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chung Hei Wong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mary Ho
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Ryan Kin Ho Sze
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
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11
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Sun Z, Cao DM, Zhang Y, Zhou HZ. Preliminary clinical report of alternate episodes of Posner-Schlossman syndrome and viral keratitis. Transpl Immunol 2022; 74:101673. [PMID: 35863606 DOI: 10.1016/j.trim.2022.101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
Posner-Schlossman syndrome (PSS) and viral keratitis have a shared pathogen and are common diseases in China, but there are few case reports on whether these two diseases occur concurrently or alternately. After long-term clinical observations, six patients with alternating episodes of PSS and viral keratitis were confirmed at our hospital in the past 10 years. Of the six patients, three were female and three were male. Four patients had monocular PSS with ipsilateral monocular viral keratitis, one had monocular PSS with bilateral viral keratitis, and one had bilateral PSS with bilateral viral keratitis. Of the six cases, three had epithelial viral keratitis and three had endothelial viral keratitis. In four cases, the interval between the onset of the two diseases ranged from 8 days to 3 years, and two cases showed overlapping manifestations of the two diseases in 3 to 6 days, both with incomplete absorption of keratic precipitates. The six cases had intermittent episodes of both diseases and significant loss of corneal sensation during the onset of viral keratitis, and were effectively treated with antiviral therapy. PSS and viral keratitis may alternate episodically, and clinical attention should be paid to these conditions. The mechanism of the alternate episodes might be associated with viral infection and the use of glucocorticoids.
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Affiliation(s)
- Zhong Sun
- Aier Eye Hospital of Wuhan University, Wuhan 430060, China
| | - Dan-Min Cao
- Aier Eye Hospital of Wuhan University, Wuhan 430060, China
| | - Yin Zhang
- Aier Eye Hospital of Wuhan University, Wuhan 430060, China
| | - He-Zheng Zhou
- Aier Eye Hospital of Wuhan University, Wuhan 430060, China.
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12
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Fan X, Li Z, Zhai R, Sheng Q, Kong X. Clinical characteristics of virus-related uveitic secondary glaucoma: focus on cytomegalovirus and varicella zoster virus. BMC Ophthalmol 2022; 22:130. [PMID: 35317777 PMCID: PMC8938591 DOI: 10.1186/s12886-022-02348-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis. Methods In this retrospective study, we enrolled patients with anterior uveitic secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS, and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments. Results We found that 53.2% (25/47) patients with PSS were CMV-positive. Patients with CMV-positive PSS had a larger cup-to-disc ratio (p = .043), lower CEC density (p = .017), more severe CEC loss (p < .001), and more iris depigmentation (p = .006) than CMV-negative PSS patients. Compared with patients with CMV-positive PSS, those with VZV-AUSG were older (p = .003), presented a higher IOP (p = .015), and had poorer BCVA (p < .001). Patients with CMV-positive PSS and VZV-AUSG all accepted ganciclovir treatment, and those with CMV-positive PSS used fewer antiglaucoma agents simultaneously compared with CMV-negative PSS (p = .005) and VZV-AUSG (p < .001). All three groups had a comparable proportion of patients requiring antiglaucoma surgery. Conclusions We observed some distinctive clinical features in CMV-positive PSS compared with CMV-negative PSS. Further, we found that patients with VZV-AUSG presented with a higher IOP and worse visual acuity, and required more antiglaucoma medication than those with CMV-positive PSS.
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Affiliation(s)
- Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Zhizhe Li
- Department of Ophthalmology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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13
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Van Gelder RN. Molecular Diagnostics for Ocular Infectious Diseases: LXXVIII Edward Jackson Memorial Lecture. Am J Ophthalmol 2022; 235:300-312. [PMID: 34921773 PMCID: PMC8863649 DOI: 10.1016/j.ajo.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To review the use of molecular diagnostic techniques in the management of ocular infectious disease. DESIGN Retrospective review. METHODS A combination of literature review and personal recollections are used. RESULTS Although the broad term molecular diagnostics may encompass techniques to identify pathogens via protein or metabolomic signatures, this review concentrates on detection of pathogen nucleic acid as an indicator of infection. The introduction of the polymerase chain reaction (PCR) in 1985 opened a new era in analysis of nucleic acids. This technique was soon applied to the detection of potential pathogen DNA and RNA, including viruses, bacteria, and parasites in infectious eye disease. Advances in PCR have allowed class-specific diagnostics (ie, pan-bacterial and pan-fungal), quantitation of pathogen DNA, and multiplexed testing. The Human Genome Project in the early 2000s greatly accelerated development of DNA sequencers, ushering in the era of "Next Generation Sequencing" and permitting pathogen-agnostic methods for the detection of potential infectious agents. Most recently, new technologies such as nanopore sequencing have reduced both cost and equipment requirements for whole-genome sequencing; when coupled with real-time sequence analysis methods, these methods offer the promise of true, real-time, point-of-service ocular infectious disease diagnostics. CONCLUSIONS Molecular methods for pathogen detection have greatly advanced the diagnosis of ocular infectious disease. Further methodologic advances will have a direct impact on the management of these conditions.
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Affiliation(s)
- Russell N Van Gelder
- From the Departments of Ophthalmology, Biological Structure, and Laboratory Medicine and Pathology, and Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine, Seattle, Washington, USA.
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14
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Ono T, Iwasaki T, Terada Y, Mori Y, Nejima R, Ozaki M, Mochizuki M, Miyata K. Long-term outcome in corneal endotheliitis with molecular detection of herpes simplex virus 1 and human herpes virus 6: a case report. BMC Ophthalmol 2022; 22:48. [PMID: 35105322 PMCID: PMC8808982 DOI: 10.1186/s12886-022-02274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human herpesvirus 6B (HHV-6B) is known to cause exanthema subitem and has been detected in various ocular diseases, including keratitis, uveitis, optic neuritis, and endophthalmitis; however, the long-term outcome after the reactivation of HHV-6B has not been well-addressed. Sugita et al. previously reported the concomitant presence of HHV-6B with herpes simplex virus-1 (HSV-1) in the aqueous fluid at the onset of corneal endotheliitis. We focused on the same patient with corneal endotheliitis, in whom both HSV-1 and HHV-6B sequences were observed, and reported the clinical course and long-term outcomes. CASE PRESENTATION A 64-year-old woman was referred to our center for visual disturbances in the left eye. Her best-corrected visual acuity in the left eye was 0.5 and the left intraocular pressure was elevated to 33 mmHg. Mid-sized keratic precipitates and 2+ cells were observed in the anterior chamber with corneal endothelial edema and reduction of the corneal endothelial cell density to 1828 cells/mm2. The patient was diagnosed with corneal endotheliitis with increased intraocular pressure. Polymerase chain reaction analysis revealed the concomitant presence of both HSV-1 and HHV-6B sequences in the left aqueous fluid. After treatment with oral valacyclovir and topical betamethasone, her intraocular inflammation gradually improved and has not recurred at 12 years after corneal endotheliitis onset although corneal opacity remained. CONCLUSIONS Reactivation of HHV-6B infection might be associated with HSV-1 corneal endotheliitis; however, no serious late sequelae occurred after appropriate treatment for HSV-1 infection in this immunocompetent host.
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Affiliation(s)
- Takashi Ono
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan. .,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Takuya Iwasaki
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Yukiko Terada
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan.,Department of Ophthalmology, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan
| | - Yosai Mori
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Ryohei Nejima
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | | | - Manabu Mochizuki
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Kazunori Miyata
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
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15
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Nora RLD, Putera I, Mayasari YD, Hikmahwati W, Pertiwi AM, Ridwan AS, Sitompul R, Westcott M, Chee SP, Pavesio C, Thng ZX, Gupta V, Agrawal R. Clinical characteristics and treatment outcomes of Cytomegalovirus anterior uveitis and endotheliitis: a systematic review and meta-analysis. Surv Ophthalmol 2021; 67:1014-1030. [PMID: 34954093 DOI: 10.1016/j.survophthal.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
Cytomegalovirus (CMV) anterior uveitis is the most common form of ocular manifestation of CMV in immunocompetent individuals. The difficulty in diagnosing CMV anterior uveitis may delay adequate treatment and affect outcomes. We sought to review systemically the overall clinical characteristics and compare treatment outcomes in CMV anterior uveitis and endotheliitis. A literature search was performed, and studies describing clinical characteristics, treatment regimens, and outcomes that included more than five treated eyes were included. In these 23 studies, acute CMV anterior uveitis commonly presented with high intraocular pressure (IOP; 95.31%, 95% CI 90.45 - 98.60) and mild anterior chamber inflammation (cells >2+ = 3.18%, 95% CI 0.21- 8.54). About two-thirds of CMV endotheliitis cases presented with high IOP and coin-shaped corneal lesions. Acute CMV anterior uveitis showed good clinical response to topical 0.15% ganciclovir (GCV) gel or oral valganciclovir (VGCV) (90%, 95% CI: 74-100% and 95%, 95% CI: 88-100%, respectively). For chronic CMV anterior uveitis, both topical GCV and oral VGCV yielded comparable results. Topical 0.5-2% GCV or a combination of topical and oral VGCV for CMV endotheliitis both resulted in good clinical response. Recurrence of inflammation was common after cessation of maintenance therapy. Overall, topical GCV resulted in an optimal outcome for CMV anterior uveitis. Escalated concentration and frequency of usage are needed for chronic CMV anterior uveitis and endotheliitis. Adequate induction and maintenance phases of anti-CMV treatment seem necessary to prevent recurrences.
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Affiliation(s)
- Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Yuri Dwi Mayasari
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Wandya Hikmahwati
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Adinda Mulya Pertiwi
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Asri Salima Ridwan
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Ratna Sitompul
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK; University College London Institute of Ophthalmology, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Post Graduate Institute of Medical Education and Research, Chandigarh, India; Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK; University College London Institute of Ophthalmology, London, UK
| | - Zheng Xian Thng
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK; Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Singapore Eye Research Institute, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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16
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Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus, and Cytomegalovirus. Am J Ophthalmol 2021; 227:191-200. [PMID: 33773985 DOI: 10.1016/j.ajo.2021.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine distinguishing features of the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV). DESIGN Retrospective, multicenter case series. METHODS Consecutive patients with herpetic AU examined at 11 tertiary centers in Japan between January 2012 and December 2017 and who were followed for ≥3 months were evaluated. Diagnosis was made by polymerase chain reaction (PCR) for HSV, VZV, or CMV in the aqueous humor, or classical signs of herpes zoster ophthalmicus. RESULTS This study enrolled 259 herpetic AU patients, including PCR-proven HSV-AU (30 patients), VZV-AU (50), and CMV-AU (147), and herpes zoster ophthalmicus (32). All HSV-AU and VZV-AU patients were unilateral, while 3% of CMV-AU patients were bilateral. Most HSV-AU and VZV-AU patients were sudden onset with an acute clinical course, while CMV-AU had a more insidious onset and chronic course. There were no significant differences for all surveyed symptoms, signs, and complications between HSV-AU and VZV-AU. However, significant differences were detected for many items between CMV-AU and the other two herpetic AU types. Ocular hyperemia and pain, blurring of vision, ciliary injection, medium-to-large keratic precipitates (KPs), cells and flare in the anterior chamber, and posterior synechia significantly more often occurred in HSV-AU and VZV-AU vs CMV-AU. In contrast, small KPs, coin-shaped KPs, diffuse iris atrophy, elevated intraocular pressure, and glaucoma surgery were significantly more frequent in CMV-AU vs HSV-AU and VZV-AU. CONCLUSION This multicenter, retrospective study identified distinguishing features of HSV-AU, VZV-AU, and CMV-AU.
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17
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Babu K, Konana VK, Ganesh SK, Patnaik G, Chan NSW, Chee SP, Sobolewska B, Zierhut M. Viral anterior uveitis. Indian J Ophthalmol 2021; 68:1764-1773. [PMID: 32823392 PMCID: PMC7690545 DOI: 10.4103/ijo.ijo_928_20] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner-Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann-Witmer coefficient analysis on the aqueous humor may help in identifying etiology to plan and monitor treatment.
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Affiliation(s)
- Kalpana Babu
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Vinaya Kumar Konana
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Sudha K Ganesh
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Gazal Patnaik
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nicole S W Chan
- Department of Ophthalmology, National University Hospital, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre; Singapore Eye Research Institute; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Duke-NUS Graduate Medical School Singapore, Singapore
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18
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Papasavvas I, Herbort CP. Cytomegalovirus Anterior Uveitis from the Perspective of the Common Practitioner: Missed Diagnosis Can Be at the Origin of Severe Functional Loss - A Scenario to Be Avoided. Klin Monbl Augenheilkd 2021; 238:448-453. [PMID: 33930916 DOI: 10.1055/a-1425-4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Carl Peter Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
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19
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Radosavljevic A, Agarwal M, Chee SP, Zierhut M. Epidemiology of Viral Induced Anterior Uveitis. Ocul Immunol Inflamm 2021; 30:297-309. [PMID: 33617392 DOI: 10.1080/09273948.2020.1853177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations.Methods: Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020.Results: A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed.Conclusion: HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Duke-NUS Medical School, Singapore
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tubingen, Tubingen, Germany
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20
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Muñoz-Ortiz J, Rubio-Romero OL, Cedeño MC, Arteaga-Rivera K, de-la-Torre A. A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfection: a case report. BMC Ophthalmol 2020; 20:479. [PMID: 33287739 PMCID: PMC7720502 DOI: 10.1186/s12886-020-01748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background We report a case of white circular spots of iridian atrophy, which we will call “polka dots” pattern, as a rare ophthalmological finding associated with uveitis secondary to varicella-zoster virus and Toxoplasma gondii coinfection in a male patient in Bogotá, Colombia. Case presentation We present de case of a 53-year-old Colombian male patient with a diagnosis of anterior uveitis in his left eye due to varicella-zoster virus and Toxoplasma gondii coinfection documented by polymerase chain reaction analysis. He presented with multiple areas of superficial white circular spots of iridian atrophy in 360º, some with deeper atrophy where the stroma fibers were visualized and only a small punctate defect of transillumination was evident. This rare pattern of iridian atrophy has not been previously described in cases of uveitis in the literature. Conclusions This is the first case reporting the findings of superficial “polka dots” pattern iridian atrophy in 360° secondary to anterior uveitis due to the coinfection of a virus and a parasite. The identification of similar clinical cases may lead to early initiation of systemic treatment in these patients.
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Affiliation(s)
- Juliana Muñoz-Ortiz
- Escuela Barraquer. Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia.,NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia
| | - Olga Lorena Rubio-Romero
- NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia
| | | | - Karla Arteaga-Rivera
- Escuela Barraquer. Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
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21
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Accorinti M, Petitti L, Gaeta A, Giannini D, De Geronimo D. Viral Acute Anterior Uveitis: Clinical Signs Useful for Differential Diagnosis. Ocul Immunol Inflamm 2020; 29:1355-1362. [DOI: 10.1080/09273948.2020.1751213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Luigi Petitti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
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Cho YW, Kang HJ, Kim GN, Kim HA, Chung IY, Kim SJ. Epstein-Barr Virus-related Corneal Endotheliitis Accompanied with Secondary Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.2.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Wun Cho
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun Ji Kang
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Gyu Nam Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun A Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
| | - Seong Jae Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
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