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C.M. Deuter, J.M. Rohrbach, D. Doycheva, M. Zierhut; Intraocular Inflammation After Heart Transplantation . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2418.
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After solid organ transplantation with immunosuppressive treatment rarely intraocular inflammation has been described. In case of a posttransplantation lymphoproliferative disorder (PTLD), Epstein–Barr virus (EBV) seems to play a major role.
We present 3 patients with uveitis after heart transplantation.
Three patients (2 male, 1 female, age 7, 8 and 44 years) were diagnosed with anterior uveitis with iris nodules (the two young boys) or intermediate uveitis. All three patients had a heart–transplantation and were on a double immunosuppression. While in the first two cases EBV–load was found massively elevated (in one patient EBV was also stainable in an iris biopsy), diagnostic vitrectomy (ppV) in the third patient was not able to demonstrate a viral, bacterial or lymphoma origin, but disclosed a polyclonal lymphocytic proliferation. Also the EBV–viral load was not elevated. The therapy of the first 2 young children consisted of ex vivo generated anti–EBV–cytotoxic T–cells. This led to complete response of the iris nodules in both, but to a reduction of the EBV–load only in one child. In the third patient postoperative improvement was achieved without additional treatment.
The posttransplantation lymphoproliferative disorder (PTLD) is a rare entity, but probably with growing incidence. A few cases of uveitis have been described; rarely EBV has been detected in the eye. It seems very important to analyse the role of EBV in this disorder, because the immunotherapy with anti–EBV–cytotoxic T–cells was effective in the treatment of the uveitis, in one patient also leading to a massive reduction of the EBV–load. The etiology of the uveitis in patient number three remains unclear.
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