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Chuckpaiwong V, Phimpho P, Lekhanont K, Kaewkorn P, Jongkhajornpong P. Epstein-Barr Virus Keratouveitis-Induced Malignant Glaucoma After Penetrating Keratoplasty: A Case Report and Literature Review. Ocul Immunol Inflamm 2024; 32:1205-1211. [PMID: 37155286 DOI: 10.1080/09273948.2023.2208659] [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: 12/12/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To report a case of Epstein-Barr virus (EBV) keratouveitis-induced malignant glaucoma after repeat penetrating keratoplasty (PK). METHODS Retrospective review of the patient's medical records and review of literature on EBV corneal endotheliitis and/or anterior uveitis. RESULTS A 78-year-old Thai female patient presented with a markedly edematous corneal graft, dense pigmented keratic precipitates, fibrinous anterior chamber reaction, uniformly flat anterior chamber, and ocular hypertension of 55 mmHg in the left eye on the first day after the third PK. An aqueous tap for polymerase chain reaction analysis was positive for EBV DNA but negative for other herpesviruses. The patient was diagnosed with EBV endotheliitis and anterior uveitis-induced malignant glaucoma; and successfully treated with oral valacyclovir and topical 2% ganciclovir eye drops. CONCLUSIONS EBV endotheliitis and anterior uveitis can induce malignant glaucoma following PK. A high index of suspicion is required when a patient has a history of unexplained multiple graft rejections.
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MESH Headings
- Humans
- Keratoplasty, Penetrating/adverse effects
- Female
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/virology
- Eye Infections, Viral/etiology
- Eye Infections, Viral/drug therapy
- Aged
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/virology
- Uveitis, Anterior/virology
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/etiology
- Uveitis, Anterior/drug therapy
- Herpesvirus 4, Human/genetics
- Intraocular Pressure
- Antiviral Agents/therapeutic use
- DNA, Viral/analysis
- Ganciclovir/therapeutic use
- Aqueous Humor/virology
- Valacyclovir/therapeutic use
- Keratitis/virology
- Keratitis/diagnosis
- Keratitis/etiology
- Keratitis/drug therapy
- Endothelium, Corneal/virology
- Endothelium, Corneal/pathology
- Glaucoma/etiology
- Glaucoma/virology
- Glaucoma/diagnosis
- Glaucoma/surgery
- Polymerase Chain Reaction
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Affiliation(s)
| | | | | | - Puttiya Kaewkorn
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Passara Jongkhajornpong
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Li Y, Zhang P, Feng L, Wang Y, Dong X, Hong J. Etiological analysis of ocular herpes virus infection. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06550-6. [PMID: 39023787 DOI: 10.1007/s00417-024-06550-6] [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: 01/14/2024] [Revised: 05/25/2024] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To do the etiological analysis of ocular herps virus infection, revealing the pathogen species and the distribution of different virus types within the eye. METHODS Samples were collected from 2017 to 2021 at the Department of Ophthalmology, Peking University Third Hospital and tested using real-time PCR for common ocular viruses: herpes simplex virus 1 (HSV-1), cytomegalovirus (CMV), varicella-zoster virus (VZV) and Epstein-Barr virus (EBV). The pathogenesis of the different viruses was classified and analyzed according to the site of infection. RESULTS Viral PCR detections were performed on 3627 samples collected over the 5-years and 649 (17.89%) samples contained one or more of the viruses tested. The overall detection rate of CMV was highest at 9.93%. Of all sample types, aqueous humor was the most common (1752 cases), of which 340 were positive (19.41% positive rate). Corneal samples were the next most common, with 1481 cases and 250 positive results (16.88% positive rate). CMV positivity was higher in aqueous humor and corneal samples than other viruses; vitreous body had the highest positive rate at 36.36% (20/55), among which 18 cases were VZV positive. CONCLUSIONS Distribution of virus types differed among infection sites, with CMV the most common virus type detected in the cornea and aqueous humor, while VZV was the most common virus detected in the vitreous body.
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Affiliation(s)
- Yingyu Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Pei Zhang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lina Feng
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xuran Dong
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Jing Hong
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
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Li Y, Miller CG, Brucker AJ, Bhatt NP, Pulido JS. DIAGNOSTIC AND THERAPEUTIC CHALLENGES. Retina 2024; 44:1111-1113. [PMID: 37756662 DOI: 10.1097/iae.0000000000003948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
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Ngathaweesuk Y, Hendrikse J, Groot-Mijnes JDFD, de Boer JH, Hettinga YM. Causes of infectious pediatric uveitis: A review. Surv Ophthalmol 2024; 69:483-494. [PMID: 38182040 DOI: 10.1016/j.survophthal.2023.12.003] [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: 08/07/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Infectious pediatric uveitis is a rare disease that can cause severe ocular damage if not detected rapidly and treated properly. Additionally, early identification of an infection can protect the child from life-threatening systemic infection. Infectious uveitis can be congenital or acquired and may manifest as a primary ocular infection or as a reactivation. Nevertheless, publications on infectious paediatric uveitis are usually limited to a small number of patients or a case report. So far, most studies on uveitis in children have focused primarily on noninfectious uveitis, and a systematic study on infectious uveitis is lacking. In this review, we summarize the literature on infectious uveitis in pediatric populations and report on the epidemiology, pathophysiology, clinical signs, diagnostic tests, and treatment. We will describe the different possible pathogens causing uveitis in childhood by microbiological group (i.e. parasites, viruses, bacteria, and fungi). We aim to contribute to early diagnosis and management of infectious pediatric uveitis, which in turn might improve not only visual outcome, but also the general health outcome.
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Affiliation(s)
- Yaninsiri Ngathaweesuk
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Jytte Hendrikse
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Jolanda Dorothea Francisca de Groot-Mijnes
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joke Helena de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Ding X, Zhang X, Lin X, Doan T, Moussa K. DIAGNOSTIC AND THERAPEUTIC CHALLENGES. Retina 2024; 44:741-743. [PMID: 37748438 DOI: 10.1097/iae.0000000000003936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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Moussa K, Gonzales JA, Shantha J, Acharya NR, Doan T. Prevalence of Epstein-Barr Virus in Patients with Intraocular Inflammation. Ocul Immunol Inflamm 2023; 31:978-980. [PMID: 35708307 PMCID: PMC10424495 DOI: 10.1080/09273948.2022.2075760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/02/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
The relationship between Epstein-Barr virus (EBV) infection and uveitis is unclear. We conducted an observational cross-sectional study to determine the prevalence of EBV in uveitis and to describe the clinical features of EBV-positive uveitis cases. This study was carried out at the F.I. Proctor Foundation at the University of California, San Francisco. All patients with suspected infectious uveitis who underwent unbiased metagenomic deep sequencing (MDS) were included. Demographics, testing information, and clinical features were documented. Eleven out of 288 patients with suspected infectious uveitis had EBV detected by RNA-seq in intraocular fluid. The prevalence of EBV in uveitis in our study sample is 4%. Three out of 11 EBV-positive eyes (27%) were found to have biopsy-proven vitreoretinal lymphoma. Future studies are needed to determine if EBV may drive the development of vitreoretinal lymphoma and if its presence should heighten the suspicion of vitreoretinal lymphoma.
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Affiliation(s)
- Kareem Moussa
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA
- F.I. Proctor Foundation, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - John A. Gonzales
- F.I. Proctor Foundation, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - Jessica Shantha
- F.I. Proctor Foundation, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - Nisha R. Acharya
- F.I. Proctor Foundation, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - Thuy Doan
- F.I. Proctor Foundation, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
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Silpa-archa S, Rangseechamrat N, Sriyuttagrai W. Recalcitrant infectious uveoscleritis: A case report of a coinfection by Epstein-Barr virus and Talaromyces marneffei. Ann Med Surg (Lond) 2022; 80:104283. [PMID: 36045833 PMCID: PMC9422309 DOI: 10.1016/j.amsu.2022.104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance In an immunocompromised patient, there has never been a report of Epstein-Barr virus (EBV) and Talaromyces marneffei co-infection. Treatment with intravenous ganciclovir for EBV-associated uveitis has only been explored in a few cases. Case presentation A 47-year-old HIV-positive female presented with scleral nodule and vascularized iris tumor in the left eye. After the ancillary laboratory workup, EBV was detected by polymerase chain reaction on aqueous humor and scleral tissue analysis. The lesion subsided completely with systemic and local ganciclovir therapy. Subsequently, recurrent scleral nodule with iris plaque developed and was pathologically diagnosed as Talaromyces marneffei. The employed treatment, including intravenous amphotericin B and intracameral amphotericin B injection, was successful in attaining a significant regression of the lesion. Clinical discussion Although EBV treatment is debatable, our combination of systemic and local ganciclovir therapy demonstrated regression of EBV-caused scleral nodule and iris plaque. The organism's identification was complicated by Talaromyces marneffei, but it was easily treated. Conclusions In HIV-infected patients, EBV-associated sclerouveitis can be successfully treated with systemic and local ganciclovir therapy, and there is a possibility of coinfection with Talaromyces marneffei. EBV can co-exist with Talaromyces marneffei causing severe sclerouveitis. EBV-associated sclerouveitis can be successfully treated with ganciclovir therapy. Sclerouveitis in an immunocompromised patient can be disastrous due to its progressive course and visual deterioration.
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Suzuki K, Namba K, Hase K, Mizuuchi K, Iwata D, Ito T, Kitaichi N, Takase H, Ishida S. A case of Epstein-Barr virus acute retinal necrosis successfully treated with foscarnet. Am J Ophthalmol Case Rep 2022; 25:101363. [PMID: 35146210 PMCID: PMC8818534 DOI: 10.1016/j.ajoc.2022.101363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/27/2021] [Accepted: 01/22/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Epstein-Barr virus (EBV) is a herpes virus known to cause infectious mononucleosis and several other human disorders. Ocular EBV infections that have been reported include uveitis, retinal vasculitis, and acute retinal necrosis (ARN). ARN is usually caused by herpes simplex virus (HSV) or varicella-zoster virus (VZV). ARN that is caused by EBV (EBV-ARN) is rarely seen, and only a few cases have been reported. The visual prognosis for EBV-ARN is poor, and no treatment strategy has been established. We report on a patient who was treated successfully for EBV-ARN. Observation An 80-year-old female who had been treated with prednisolone at 5 mg/day and methotrexate at 2 mg/week for rheumatoid arthritis visited our hospital because of blurred vision in her left eye. Her left visual acuity was 20/50, and extensive white-yellowish retinal lesions at the temporal periphery with retinal hemorrhages were seen through vitreous haze. The DNA sequence of EBV, but not of HSV, VZV, or cytomegalovirus, was detected by a polymerase chain reaction (PCR) assay in the aqueous humor (4.2 × 106 copies/ml), with EBV also being positive in serum (3.5 × 102 copies/ml). The patient received 2 mg of intravitreal ganciclovir injections twice with a 3-day interval and intravenous infusion of acyclovir at 750 mg/day for 7 days; however, the retinal white lesions expanded rapidly, then dose of prednisolone was increased (40 mg/day) and vitrectomy was performed 10 days after the initial visit. After the surgery, the retinal lesion continued to enlarge. Vitreous samples showed high copies of EBV (1.2 × 108 copies/ml). Following treatment with intravenous foscarnet (4800 mg/day), which replaced the acyclovir application, the retinal white lesions gradually diminished, leaving retinal scars. To date, the patient has developed no retinal detachment and shows visual acuity over 6/60 in the left eye along with silicone oil. Conclusions We experienced a case of EBV-ARN that was refractory to systemic acyclovir and topical ganciclovir but responded effectively to systemic foscarnet after vitrectomy. Although the clinical management remains challenging in this disease, foscarnet is considered to be one of the candidate drugs for EBV infections.
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Affiliation(s)
- Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Corresponding author. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Keitaro Hase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takako Ito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Silpa-Archa S, Sriyuttagrai W, Foster CS. Treatment for Epstein-Barr Virus-associated uveitis confirmed by polymerase chain reaction: Efficacy of Anti-Viral Agents and a literature review. J Clin Virol 2022; 147:105079. [PMID: 35007895 DOI: 10.1016/j.jcv.2022.105079] [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: 09/20/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are still many research challenges and unanswered questions in relation to Epstein-Barr virus-associated uveitis. These include the presence of Epstein-Barr virus (EBV) DNA in asymptomatic patients, its pathogenicity in the uveitis eye, and the role of antiviral therapy for EBV-associated intraocular inflammation. METHODS This was a retrospective review of prospectively collected data from the Ophthalmology Department, Rajavithi Hospital between 2015 and 2020. A qualitative assay using multiplex real-time PCR was performed to detect pathogen genes from specimens obtained from a total of 344 patients. The main outcome measure was treatment success defined by clinical improvement and absence of viral DNA confirmed by PCR. RESULTS Of the 35 cases, 24 with complete data were enrolled in the study, including 22 with post-treatment PCR results. Sixty-seven percent were HIV-infected, and other plausible causes or coinfection with other pathogens were found in 75% of patients. Cytomegalovirus (38%) was the most common co-infecting pathogen. The most commonly employed regimen was a combination of systemic acyclovir and intravitreal ganciclovir injection (58%). Of the 22 cases who had post-treatment PCR results, absence of detection of the virus by PCR in the intraocular fluid after treatment was demonstrated in 73% of patients. CONCLUSION Patients with EBV infection can be simultaneously co-infected with other pathogens. Systemic acyclovir and ganciclovir achieved clinical improvement in most cases, and EBV infection was cured in the majority of patients.
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Affiliation(s)
- Sukhum Silpa-Archa
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400 Thailand.
| | - Wararee Sriyuttagrai
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400 Thailand
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; Ocular Immunology & Uveitis Foundation, Waltham, MA, USA; Harvard Medical School, Boston, MA, USA
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Alba‐Linero C, Rocha‐de‐Lossada C, Rachwani‐Anil R, Sainz‐de‐la‐Maza M, Sena‐Corrales G, Romano V, Rodríguez‐Calvo‐de‐Mora M. Anterior segment involvement in Epstein-Barr virus: a review. Acta Ophthalmol 2021; 100:e1052-e1060. [PMID: 34766457 DOI: 10.1111/aos.15061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
The aim of this study is to describe the involvement of Epstein-Barr Virus (EBV) in the diseases of the ocular anterior segment. This is a narrative review designed using the PUBMED, SCOPE and Web of Science databases, searching for reported literature on findings in the anterior ocular segment related to EBV between 1990 and 2020. Epstein-Barr Virus (EBV) is implicated in the development of salmon-coloured conjunctival masses in the context of acute mononucleosis and lymphoproliferative disorders. Moreover, EBV can cause haemorrhagic conjunctivitis and its corneal implications appear as different types of keratitis patterns. The involvement of EBV in the pathogenesis of anterior segment inflammation is not well-defined. Current evidence regarding anterior segment disease caused by EBV infection has been proved by positive viral detection through polymerase chain reaction test in eyes with lymphoproliferative disorders known to be caused by EBV, as B- and NK/T-cell lymphoid tumours. Antiviral treatment (oral Aciclovir or Valaciclovir) in anterior segment disease caused by EBV remains controversial.
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Affiliation(s)
- Carmen Alba‐Linero
- Hospital Clínico Universitario Málaga Málaga Spain
- Departamento Oftalmología Facultad de Medicina Universidad de Málaga Málaga Spain
| | - Carlos Rocha‐de‐Lossada
- Hospital Universitario Virgen de las Nieves Granada Spain
- Department of Ophthalmology (Qvision) Vithas Virgen del Mar Hospital Almería Spain
- Ceuta Medical Center Ceuta Spain
| | | | | | | | - Vito Romano
- Eye Clinic, Department of Neurological and Vision Sciences University of Brescia Brescia Italy
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK
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12
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Affiliation(s)
- Emmett T. Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Smit D, De Graaf M, Meyer D, de Groot-Mijnes JDF. Immunoblot and Polymerase Chain Reaction to Diagnose Ocular Syphilis and Neurosyphilis in HIV-positive and HIV-negative Patients. Ocul Immunol Inflamm 2020; 28:1049-1055. [PMID: 31944129 DOI: 10.1080/09273948.2019.1698753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To evaluate immunoblot (IB) and polymerase chain reaction (PCR) to diagnose ocular- and neurosyphilis. Methods: Prospective cross-sectional study. Aqueous humor (AH) and cerebrospinal fluid (CSF) samples were tested for treponemal DNA or antibodies to treponemal antigens. Results: Thirteen of 106 cases had positive syphilis serology of which 69.2% were HIV+ (median CD4+ = 181 cells/µL). Four cases met CDC criteria for neurosyphilis (3 confirmed, 1 probable) and 2 additional cases required neurosyphilis treatment according to UpToDate algorithms. All AH and CSF samples tested PCR negative. Five cases were CSF IB+ and 3 cases AH IB+. Using our classification, eight patients had confirmed neurosyphilis, one had probable neurosyphilis, three had confirmed ocular syphilis and nine had probable ocular syphilis. Conclusion: Our findings suggest that IB of AH and CSF provides additional evidence to diagnose ocular and neurosyphilis and allows us to classify them as probable or confirmed.
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Affiliation(s)
- Derrick Smit
- Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Melanie De Graaf
- Medical Microbiology, University Medical Center Utrecht , Utrecht, Netherlands
| | - David Meyer
- Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
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Smit DP, Meyer D, Esterhuizen TM, De Groot-Mijnes JDF. Polymerase Chain Reaction and Goldmann-Witmer Coefficient Testing in the Diagnosis of Infectious Uveitis in HIV-Positive and HIV-Negative Patients in South Africa. Ocul Immunol Inflamm 2017; 27:189-196. [PMID: 29283745 DOI: 10.1080/09273948.2017.1407802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To use polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) calculation to diagnose infectious uveitis. METHODS Prospective cross-sectional study. RESULTS Twenty-seven of 106 patients had positive PCR and/or GWC results on aqueous humor (AH) sampling and 15 of 27 (55.6%) were HIV-positive. Patients with non-anterior uveitis (NAU) were more likely to be HIV+ (p = 0.005). More than 1 possible pathogen was identified in 9 of 27 patients of whom 7 were HIV+. The final clinical diagnosis was discordant with AH findings in 9 of 27 cases. A positive EBV PCR result was associated with a discordant diagnosis (p = 0.001). All cases of herpetic anterior uveitis (42.9% HIV+) tested PCR-/GWC+ while all cases of herpetic NAU tested PCR+/GWC- (83.3% HIV+). All rubella virus cases were PCR+/GWC+. CONCLUSION PCR is useful to diagnose herpetic NAU in HIV+ patients while GWC is useful to diagnose herpetic anterior uveitis.
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Affiliation(s)
- Derrick P Smit
- a Division of Ophthalmology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - David Meyer
- a Division of Ophthalmology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Tonya M Esterhuizen
- b Biostatistics Unit, Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Smit DP, Meyer D, Maritz J, De Groot-Mijnes JDF. Authors Reply to Letter to the Editor– In Response to: “Smit D, Meyer D, Maritz J, et al. Polymerase Chain Reaction and Goldmann-Witmer Coefficient to Examine the Role of Epstein-Barr Virus in Uveitis”. Ocul Immunol Inflamm 2017; 27:116. [DOI: 10.1080/09273948.2017.1406957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Derrick P. Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Meyer
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean Maritz
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and the National Health Laboratory Service, Cape Town, South Africa
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Murray PI, Fink C, Trivedi D. In Response to: Smit D, Meyer D, Maritz J, et al. “Polymerase Chain Reaction and Goldmann-Witmer Coefficient to Examine the Role of Epstein-Barr Virus in Uveitis”. Ocul Immunol Inflamm 2017; 27:114-115. [DOI: 10.1080/09273948.2017.1400075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Philip I. Murray
- Birmingham and Midland Eye Centre, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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