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Natasha V Nayak, Emile Sharifi, C Michael Samson, Sanjay Kedhar; Cytomegalovirus Anterior Uveitis in Immunocompetent Patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1864.
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To describe the clinical features and management of cytomegalovirus (CMV) associated anterior uveitis in immunocompetent patients within the United States.
Retrospective chart review of immunocompetent patients with anterior uveitis who had tested positive for CMV by polymerase chain reaction (PCR) of aqueous humour. Records were reviewed for demographics, ocular findings at presentation, laboratory results, presence of elevated intraocular pressure, and treatment.
Medical records of nine immunocompetent patients with PCR positive CMV anterior uveitis were reviewed (median age 55 years, 66% male). Ethnicity of patients were as follows: 55% East Asian, 22% Caucasian, 11% Hispanic, 11% South Asian. All patients had unilateral anterior uveitis (55% right eyes) associated with hypertensive crisis. Median age of onset of anterior uveitis was 36 years. Median best-corrected visual acuity on presentation was 0.12 (logMAR). Prior to PCR results, working diagnoses included Posner-Schlossman syndrome, Fuchs heterochromic iridocyclitis, herpes simplex virus iritis, CMV irits, and HLA-B27 associated iritis. Median interval between initial episode of anterior uveitis to PCR-based diagnosis was 3 years (range of 1-20 years). All nine patients were started on oral valgancyclovir based on PCR results. Withdrawal of oral valgancyclovir resulted in recurrence in 5 of 5 patients, when attempted. Three patients were managed with topical valgancyclovir after discontinuation of oral medication, and two patients remain on oral valgancyclovir. Eight of nine patients required long term glaucoma management, including two patients who required glaucoma surgery. Median duration of follow-up was 48 months.
This study highlights the presence of CMV associated anterior uveitis in immunocompetent patients in the United States, across various ethnicities. Management includes long-term oral or topical valgancyclovir and control of intraocular pressure.
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