Cytomegalovirus as a cause of acute endothelial cell loss in immunocompetent patients with hypertensive anterior uveitis

Abstract

Purpose: Virus has been known to play a role in the idiopathic anterior uveitis associated with ocular hypertension. In this study, we investigated the clinical characteristics of patients with anterior hypertensive uveitis and compared the characteristics between patients in cytomegalovirus (CMV)-positive group and those in CMV-negative group in their aqueous humor sample.

Methods: Medical records of forty-two patients with hypertensive anterior uveitis were analyzed retrospectively. All patients underwent slit lamp biomicroscopy examination, specular microscopy, gonioscopy, and serological test. Among 42 patients with hypertensive anterior uveitis, an aqueous sampling was done in 22 patients, and their aqueous analyzed for viral deoxyribonucleic acid by polymerase chain reaction.

Results: The average age of 42 patients with hypertensive anterior uveitis 57.6 years and 29 (69.0%) of subjects were male. Twenty-two patients (52.4%) underwent glaucoma surgery, and the average corneal endothelial cell counts were 1,908 cells/ mm2. Among 22 patients having an aqueous sampling, 6 patients showed the CMV-PCR positive, whereas 16 patients showed the CMV-PCR negative. The CMV-positive group were significantly younger (CMV-positive vs.CMV-negative: 47.5 ± 14.8 yrs vs. 67.6 ±11.8 yrs; P = 0.006) and more myopic compared with the CMV-negative group (-3.6 ± 4.2 vs. 0.0 ± 1.6D; P = 0.031). The frequency of glaucoma surgery was similar between groups (66.0% vs 66.0%, P = 0.701). However, 66.7% of CMV-positive group had glaucoma tube shunt surgery, whereas majority of CMV-negative group (80%) underwent trabeculectomy as a glaucoma surgery. Interestingly, the corneal endothelial cell counts were significantly lower in CMV-positive group, compared with CMV-negative group (1245 ± 560 cells/mm² vs 1981 ± 387 cells/mm²; P = 0.009). In the CMV-positive group, systemic ganciclovir therapy was used in 2 patients. After a 1month of gangiclovir therapy, the aqueous CMV-PCR titer was dramatically decreased in both patients. However, extensive corneal endothelial cell loss was found after 5 months later, despite the ganciclovir therapy.

Conclusions: CMV was found to be one of the etiologic factors in patients with hypertensive anterior uveitis. Special cautions are needed for patients with CMV-positive hypertensive anterior uveitis, considering its adverse effect on corneal endothelium.