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Sanchez G, Tsougranis G, Zheng H, Miller DM, Phan C, Jeng BH, Cohen E, Zegans ME. Out of sight, but not out of mind: Zoster sine herpete case study and survey of Zoster Eye Disease Study (ZEDS) Group. Am J Ophthalmol Case Rep 2024; 33:101978. [PMID: 38261902 PMCID: PMC10797137 DOI: 10.1016/j.ajoc.2023.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 11/06/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- George Sanchez
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Gregory Tsougranis
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Heavenly Zheng
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Donald M. Miller
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Cong Phan
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Bennie H. Jeng
- Dept. of Ophthalmology/Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Elisabeth Cohen
- Dept. of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Michael E. Zegans
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, NH, Lebanon
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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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3
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Al-Ani HH, Niederer RL. Zoster sine herpete: a disease that ophthalmologists should be aware of. Korean J Pain 2020; 33:403-404. [PMID: 32989207 PMCID: PMC7532302 DOI: 10.3344/kjp.2020.33.4.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Haya H Al-Ani
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Sakai JI, Usui Y, Suzuki J, Kezuka T, Goto H. Clinical features of anterior uveitis caused by three different herpes viruses. Int Ophthalmol 2019; 39:2785-2795. [DOI: 10.1007/s10792-019-01125-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/22/2019] [Indexed: 12/19/2022]
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5
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Chan NS, Chee S. Demystifying viral anterior uveitis: A review. Clin Exp Ophthalmol 2018; 47:320-333. [DOI: 10.1111/ceo.13417] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Soon‐Phaik Chee
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
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6
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Management of chronic complications associated with herpes zoster ophthalmicus. Curr Opin Ophthalmol 2018; 29:334-339. [DOI: 10.1097/icu.0000000000000492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arnold N, Messaoudi I. Herpes zoster and the search for an effective vaccine. Clin Exp Immunol 2017; 187:82-92. [PMID: 27164323 PMCID: PMC5167054 DOI: 10.1111/cei.12809] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/26/2016] [Accepted: 05/05/2016] [Indexed: 12/30/2022] Open
Abstract
Primary infection with varicella zoster virus (VZV), an exclusively human neurotrophic alphaherpsesvirus, results in varicella, known more commonly as chickenpox. Like other alphaherpesviruses, VZV establishes latency in the sensory ganglia and can reactivate to cause herpes zoster (also known as shingles), a painful and debilitating disease, especially in elderly and immunocompromised individuals. The overall incidence of herpes zoster in Europe and the United States is three per 1000 people, but increases sharply after 60 years of age to 10 per 1000 people. Zostavax® is a vaccine approved by the Federal Drug Administration for the prevention of herpes zoster. Unfortunately, this vaccine reduces the incidence of disease by only 51% and the incidence of post-herpetic neuralgia by 66·5% when administered to those aged 60 and older. Moreover, it is contraindicated for individuals who are immunocompromised or receiving immunosuppressant treatments, although they are at higher risk for herpes zoster compared to immune-competent older individuals. This paper reviews VZV pathogenesis, host responses and current vaccines available to prevent herpes zoster.
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Affiliation(s)
- N Arnold
- Graduate Program in Microbiology, University of California-Riverside, Riverside, CA, USA
| | - I Messaoudi
- Graduate Program in Microbiology, University of California-Riverside, Riverside, CA, USA
- Division of Biomedical Sciences, School of Medicine, University of California-Riverside, Riverside, CA, USA
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Mochizuki M, Sugita S, Kamoi K, Takase H. A new era of uveitis: impact of polymerase chain reaction in intraocular inflammatory diseases. Jpn J Ophthalmol 2016; 61:1-20. [PMID: 27787641 DOI: 10.1007/s10384-016-0474-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
Uveitis is a sight-threatening intraocular inflammatory disorder which may occur from both infectious and non-infectious or autoimmune causes. The frequency of infectious uveitis and autoimmune uveitis varies depending on countries and regions. According to a nationwide survey conducted by the Japanese Ocular Inflammation Society, infectious and non-infectious uveitis accounted for 16.4 and 50.1% of new patients, respectively while the remaining 33.5% of new uveitis cases were not classified or were idiopathic uveitis. Infectious uveitis is particularly important because it causes tissue damage to the eye and may result in blindness unless treated. However, it can be treated if the pathogenic microorganisms are identified promptly and accurately. Remarkable advancements in molecular and immunological technologies have been made in the last decade, and the diagnosis of infectious uveitis has been greatly improved by the application of molecular and immunological investigations, particularly polymerase chain reaction (PCR). PCR performed on a small amount of ocular samples provides a prompt, sensitive, and specific molecular diagnosis of pathogenic microorganisms in the eye. This technology has opened a new era in the diagnosis and treatment of uveitis, enabling physicians to establish new clinical entities of uveitis caused by infectious microorganisms, identify pathogens in the eyes of many patients with uveitis, and determine prompt diagnosis and appropriate therapy. Here we review the PCR process, new PCR tests specialized for ocular diseases, microorganisms detected by the PCR tests, diseases in the eye caused by these microorganisms, and the clinical characteristics, diagnosis, and therapy of uveitis.
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Affiliation(s)
- Manabu Mochizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan.
| | - Sunao Sugita
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroshi Takase
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Prevalence of Ocular Manifestations and Visual Outcomes in Patients With Herpes Zoster Ophthalmicus. Cornea 2016; 36:338-342. [DOI: 10.1097/ico.0000000000001046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Presumed Herpetic Anterior Uveitis: A Study with Retrospective Analysis of 79 Cases. Eur J Ophthalmol 2013; 24:14-20. [DOI: 10.5301/ejo.5000331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/20/2022]
Abstract
Purpose To describe the clinical features, visual outcome, medical treatment, and complications of presumed herpetic anterior uveitis. Methods We retrospectively analyzed the clinical data related to 79 eyes of 77 patients with presumed herpetic anterior uveitis seen at the Uveitis Unit of the Ulucanlar Eye Training and Research Hospital from 1996 to 2011. Age at onset of disease, sex, follow-up duration, existence of corneal involvement, posterior synechiae, distorted pupil, iris atrophy, characteristic of keratic precipitates, elevated intraocular pressure (IOP), medical treatment, recurrence rate, complications, visual acuities (VA), and surgery for complications were recorded. The complication rates in patients with and without corneal involvement were compared. Results There were 38 (49.4%) female and 39 (50.6%) male patients. The mean age at presentation was 48.5 ± 14.8 (20–82) years. The follow-up period was 26.5 (2–127) months. Two patients had bilateral involvement. Ocular findings were a corneal scar or active keratitis in 37 (46.8%) eyes, secondary glaucoma in 14 (17.7%), iris atrophy in 39 (49.4%), distorted pupil in 16 (20.3%), posterior synechiae in 23 (29.1%), and granulomatous anterior uveitis in 30 (40%) eyes. Eight (10.1%) eyes had a posterior subcapsular cataract. Glaucoma surgery was required for uncontrolled IOP with maximum medical treatment in 2 (2.4%) eyes. Long-term oral acyclovir was used in 9 (11.3%) patients. Final VA was ≤ 0.1 in 8 (10.1%) eyes; of these, 6 had either corneal scarring or cataract and 2 preexisting amblyopia. Conclusions Presumed herpetic anterior uveitis with or without keratitis has characteristic clinical findings that enable the diagnosis. Long-term prophylactic antiviral therapy should be considered especially in patients <50 years old.
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Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiadis G. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology 2002; 109:879-82. [PMID: 11986091 DOI: 10.1016/s0161-6420(02)00961-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report two cases of recurrent anterior uveitis with sectoral iris atrophy and ocular hypertension during attacks caused by cytomegalovirus (CMV). DESIGN Two observational case reports. PARTICIPANTS 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. MAIN OUTCOME MEASURES Comprehensive ophthalmic examination, aqueous humor polymerase chain reaction (PCR), and peripheral blood serologic studies were performed on both patients. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Nikos N Markomichelakis
- Ocular Inflammation and Immunology Service, Department of Ophthalmology, General Hospital of Athens, Athens, Greece
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Abstract
Herpetic eye disease is common and is frequently associated with intraocular inflammation or uveitis. Despite recent advances in measuring anti-herpes virus antibodies and viral DNA in ocular fluids, diagnosis remains largely clinical. The two more common syndromes include anterior uveitis, often associated with keratitis, and the acute retinal necrosis (ARN) syndrome. Treatment is complex and requires careful monitoring to provide the appropriate balance of antiviral medication and corticosteroids. Long-term prophylaxis with oral antiviral agents may be required in selected patients to help prevent the vision-compromising complications associated with recurrences.
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Affiliation(s)
- B D Gaynor
- Francis I. Proctor Foundation, UCSF, Medical Center 94143, USA
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Affiliation(s)
- N K Wade
- Department of Ophthalmology, University of British Columbia, Vancouver Hospital Eye Care Center, Canada
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Abstract
PURPOSE To report a case of zoster sine herpete with bilateral ocular involvement. METHOD Case report. RESULTS A 65-year-old man showed bilateral iridocyclitis with sectoral iris atrophy and elevated intraocular pressure unresponsive to steroid treatment. No cutaneous eruption was manifest on the forehead. A target region of varicella-zoster virus DNA sequence was amplified from the aqueous sample from the left eye by polymerase chain reaction. Bilateral iridocyclitis resolved promptly after initiation of systemic and topical acyclovir treatment. Secondary glaucoma was well controlled by bilateral trabeculectomy. CONCLUSIONS Zoster sine herpete should be considered and polymerase chain reaction performed on an aqueous sample to detect varicella-zoster virus DNA for rapid diagnosis whenever anterior uveitis accompanies the characteristic iris atrophy, even in the case of bilateral involvement.
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Affiliation(s)
- M Nakamura
- Department of Ophthalmology, Kobe University School of Medicine, Kobe, Japan.
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Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a distinct clinical entity among herpetic eye diseases. Ophthalmology 2000; 107:1164-70. [PMID: 10857838 DOI: 10.1016/s0161-6420(00)00115-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To determine the cause and describe the clinical features of unilateral anterior uveitis with sectoral atrophy of the iris in the absence of associated keratitis. DESIGN Retrospective, observational case series. PARTICIPANTS Thirty-one patients with unilateral anterior uveitis with sectoral iris atrophy and without (previous) keratitis. METHODS The patients were selected from our database of 592 patients with anterior uveitis. MAIN OUTCOME MEASURES We reviewed the clinical data on the 31 patients and the results of diagnostic anterior chamber fluid analysis for 24 of the 31 patients. Specifically, production of local antibodies against herpes simplex virus (HSV) and varicella zoster virus (VZV) was determined and the polymerase chain reaction was performed to demonstrate the DNA of HSV, VZV, and cytomegalovirus (CMV) in the aqueous samples. RESULTS Main clinical characteristics of anterior uveitis with iris atrophy included unilateral involvement with a prolonged course and recurrent exacerbations in all cases. Elevated intraocular pressure during intraocular inflammation occurred in 90% of patients (28 of 31). Visual outcome was favorable because 29 of 31 patients (94%) retained a visual acuity of 20/32 or more. The causal agent was identified as HSV in 83% (20 of 24) and VZV in 13% (3 of 24) and was inconclusive in one case. The patients with HSV uveitis were younger than those with VZV uveitis (mean age at onset 34 and 65 years, respectively; P = 0.0056). CONCLUSIONS Unilateral anterior uveitis with sectoral atrophy of the iris without associated (previous) keratitis is a distinct entity among herpetic eye diseases. Recurrent unilateral anterior uveitis with iris atrophy and/or elevated intraocular pressure has most likely been caused by HSV.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Aged
- Antibodies, Viral/analysis
- Aqueous Humor/virology
- Atrophy
- Child
- DNA, Viral/analysis
- Eye Infections, Viral/complications
- Eye Infections, Viral/virology
- Female
- Herpes Simplex/complications
- Herpes Simplex/virology
- Herpes Zoster Ophthalmicus/complications
- Herpes Zoster Ophthalmicus/virology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/immunology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Humans
- Intraocular Pressure
- Iris/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Retrospective Studies
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/etiology
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Affiliation(s)
- A Van der Lelij
- Department of Ophthalmology, University Medical Centre, Utrecht, The Netherlands
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