Abstract
Purpose: :
Cytomegalovirus (CMV)-associated anterior uveitis (AU) in immunocompetent patients is a newly described entity, with only 118 cases reported so far. Since 2002, we are performing polymerase chain reaction (PCR) analysis of aqueous humor for CMV identification in chronic or relapsing idiopathic hypertensive AU. The aim of this study is to describe the clinical profile of a large series of patients with PCR-proven CMV-associated AU.
Methods: :
Demographic data, history, ocular findings, visual field and visual acuity (VA) of HIV-negative patients with CMV PCR-positivity managed between 2003 and 2009 were retrospectively reviewed.
Results: :
Aqueous humor was obtained from 63 patients with chronic or relapsing idiopathic hypertensive AU. Thirty-four eyes (54%) demonstrated positive results for CMV but not for other herpes viruses. Twenty-four eyes (70%) had recurrent attacks (Posner-Scholssman Syndrome-like, PSS) and 10 (30%) had chronic AU (CAU). Eight were women and 26 (76%) were men. The mean age was 50 years (range:19-85), with CAU patients being significatively older than PSS (65 vs 43, p<0.005). Mean intraocular pressure (IOP) at diagnosis was 33±7 mmHg despite topical treatment and systemic acetazolamide (32%). Twenty-five (74%) were also under local steroids. Keratic precipitates were present in all cases, either as grey, round and central (70%) or as small, brown and peripheral (30%). Iris atrophy was present in 8 (24%) patients and anterior chamber cells in 20 cases (59%). Mean initial VA was 20/25 but optic disc cupping was abnormal in 22 cases (65%) and visual field defects were present in 21 (62%) patients. The mean time to diagnosis was 66 months (range : 4-240), 12 (35%) patients have been previously treated unsuccessfully with acyclovir, 17 (50%) had previous AC tap for herpes viruses, but not for CMV.
Conclusions: :
CMV is responsible for more than 50% of cases of idiopathic hypertensive AU. Despite a good visual acuity, most of these patients suffer from visual field alterations and misuse of topical corticosteroids. Therefore, rapid viral identification and initiation of an appropriate antiviral treatment remain mandatory.
Keywords: uveitis-clinical/animal model • cytomegalovirus • intraocular pressure