Molecular Diagnosis and Therapeutic Modalities of Chronic Cytomegalovirus Uveitis Without Retinitis

Abstract

Abstract: : Purpose: CMV uveitis may occur in the absence of retinal necrosis in immunocompetent patients. The aim of our study was to define the clinical features and the diagnostic and therapeutic management of this condition. Patients and methods : Patients referred between 2001 and 2004 for management of unilateral, chronic, relapsing uveitis associated with secondary glaucoma underwent extensive work–up, including laboratory tests for different herpesvirus infections. Specific antiviral treatment was initiated in all cases and the level of ocular inflammation was evaluated during the follow–up. Results:Seven patients, 5 men and 2 women were included. Mean age was 45.3 years (range 17–80 years). Anterior unilateral chronic uveitis without iris atrophy was observed in all cases. Slit lamp biomicroscopy disclosed presumable viral uveitis in 3 cases and Posner–Schlossman like syndrome in 4 cases. Mean intraocular pressure was 30.5 mmHg (range 22–43 mmHg). All patients responded initially to specific anti–CMV therapy. Ocular inflammation and glaucoma were controlled in all cases, but relapses occurred in 3 cases, requiring prolonged maintenance therapy with valganciclovir.Conclusions: Viral–like uveitis may be resistant to acyclovir. CMV infection should be considered in order to propose specific antiviral therapy. Maintenance regimens of valganciclovir are mandatory to prevent further relapses.

Keywords: cytomegalovirus • uveitis-clinical/animal model • inflammation