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Audrey Fel, Magdalena Bojanova, Valérie Touitou, Phuc Le Hoang, Flore Rozenberg, Bahram Bodaghi; Etiologic Diversity Of Atypical And Severe Anterior Uveitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6190.
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To analyse the etiological distribution of long-lasting and severe anterior uveitis based on the analysis of the aqueous humor.
Retrospective study of patients presenting with atypical, severe anterior uveitis and managed in a tertiary referral centre, between January 2008 and December 2009. Patients with panuveitis, intermediate and posterior uveitis and those with typical B27-associated uveitis or herpes zoster ophthalmicus were excluded. Patients were divided into three groups : atypical viral uveitis (group 1), typical herpetic uveitis (group 2), Fuchs uveitis (group 3). An anterior chamber paracentesis was performed in all cases to exclude a viral etiology.
The medical files of 153 patients were analysed. The mean age was 49 years (range 8-83 Years), the M/F sex ratio was 1.22. Uveitis was unilateral in 86.5% of cases. Group 1 included 42 patients with sarcoidosis (13 cases), tuberculosis (7 cases), endophthalmitis (6 cases), spondylarthropathy (10 cases), syphilis (2 cases), neoplasia (2 cases) and multiple sclerosis (2 cases). Group 2 included 83 cases. A viral agent was definitely identified in 33 cases (39.8%). The distribution of herpes viruses was the following : CMV (19 cases), HSV-1 (8 cases) and VZV (6 cases). The yield of anterior chamber paracentesis is increased by repetition of the procedure (up to 77.4% for CMV). The PCR-negative patients in Group 2 responded well to a specific antiviral treatment. None of the patients with Fuchs uveitis (Group 3) had a positive PCR for CMV. HSV-2 and EBV were not identified in this group of patients.
Most cases of atypical anterior uveitis, especially when unilateral, are viral-induced. Molecular tools applied to ocular fluids can confirm a viral infection, leading to a specific antiviral therapy and an optimal control of the disease.
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