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Victor A Neamtu, Regis P Kowalski, Christina R Neamtu, Andrew Eller; The Use of Polymerase Chain Reaction from Anterior Chamber Paracentesis Samples in the Diagnosis of Suspected Infectious Posterior Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5292.
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We aimed to evaluate the diagnostic usefulness of polymerase chain reaction (PCR) testing in samples of aqueous humor from anterior chamber paracentesis of eyes with suspected infectious chorioretinitis and vitritis. We describe our experience at our tertiary care institution.
A retrospective chart review was performed, where PCR was analyzed in aqueous samples (total 38) obtained from 33 eyes of 33 patients with a diagnosis of retinitis, chorioretinitis, or vitritis of suspected infectious source. PCR samples were analyzed for the presence of Herpes Simplex (HSV) 1 and 2, Cytomegalovirus (CMV), Varicella Zoster (VZV), Epstein-Barr Virus (EBV), and Toxoplasma Gondii (Toxo). Exclusion criteria included primarily anterior segment inflammation. Patient data included demographics, presenting signs and symptoms, degree of inflammation, presence of retinitis, results of PCR testing, patient immune status, and treatment rendered pre- and post-aqueous sampling.
We identified PCR samples to be as follows: HSV1 positive in 2.6%, HSV2 positive in 15.7%, CMV positive in 15.7%, VZV positive in 7.9%, EBV positive in 5.3%, and Toxo positive in 7.9%. 22 patients (66.7%) carried a final diagnosis of infectious retinitis or vitritis, and aqueous samples were positive in 15 of those (68.1%). Of those patients with negative sampling, 16.7% ultimately were diagnosed with fungal endophthalmitis and 44.4% were diagnosed with non-infectious uveitis. 12.2% of patients had immunocompromised status, from either HIV infection on organ transplant status. The presence of retinal inflammatory lesions were significantly correlated to a positive PCR sample.
Infectious chorioretinitis is a sight-threatening condition which affects both immunocompetent and immunocompromised individuals. Timing and accurate diagnosis are key features of initiating appropriate treatment. However, diagnosis and initiation of treatment is often based on clinical suspicion alone. PCR sampling of aqueous humor is a safe procedure which can be an excellent adjunct tool in cases of suspected viral infectious etiology, as it is accurate, easily obtainable at initial presentation, and repeatable.
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