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Yosuke Harada, Ken Fukuda, Asami Nakahira, Kentaro Tada, Tamaki Sumi, Atsuki Fukushima; Variable clinical course of cytomegalovirus anterior uveitis in Japanese patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3296.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the clinical features of Japanese patients with cytomegalovirus (CMV) anterior uveitis.
We reviewed the records of patients with CMV anterior uveitis seen at Kochi Medical School from May 2011 to October 2014. All patients included in the study were confirmed to have CMV DNA in aqueous humor by polymerase chain reaction (PCR) analysis.
Thirteen immunocompetent patients (nine men and four women; total of 16 eyes) were enrolled in the study. The mean ± SD age at disease onset was 53.9 ± 16.1 years. Although three patients (23.1%) initially tested negative for the presence of CMV DNA in aqueous humor, specimens obtained at a later time from these patients tested positive at a second analysis. Four patients (30.8%) were previously diagnosed with Posner-Schlossman syndrome. Coin-shaped keratic precipitates were observed in 11 patients (84.6%), corneal endothelial cell loss in nine eyes (56.3%), and elevation of intraocular pressure (IOP) in all patients. Twelve patients (92.3%) received systemic anti-CMV therapy such as oral valganciclovir or intravenous ganciclovir. In addition, 12 patients (92.3%) were treated with 1% topical ganciclovir solution and topical corticosteroid. Ocular inflammation was resolved and IOP declined to normal levels after treatment initiation in all patients, but six individuals (50%) experienced disease recurrence during tapering off or after termination of systemic anti-CMV therapy. Systemic antiviral therapy was terminated in all patients who did not experience corneal endothelial loss. Five out of eight patients (62.5%) with corneal endothelial cell loss had to continue systemic therapy for recurrent inflammation or IOP elevation.
Confirmation of a diagnosis of CMV anterior uveitis requires the detection of CMV DNA in aqueous humor by PCR analysis. However, one-fourth of patients were negative for CMV DNA at initial examination. For patients with a suspected clinical diagnosis of CMV anterior uveitis, it is therefore important to repeat the analysis at a later time if the initial PCR test is negative. Finally, patients with corneal endothelial cell loss are likely to be resistant to antiviral therapy and to require longer treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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