EBV–associated uveitis diagnosed by polymerase chain reaction (PCR): report of 3 cases

Abstract

Abstract: : Purpose: Epstein–Baar virus (EBV)–associated uveitis is not a well–known etiology of chronic uveitis. Its diagnostic and therapeutic management is not clearly established. We report here the clinical features and the therapeutic management of patients presenting with EBV–associated uveitis. Methods: Medical records of patients presenting with EBV–associated uveitis among all those who have a suspicion of viral uveitis during 2003 were retrospectively reviewed. An extensive work–up including viral serology for different herpes viruses was performed in order to confirm the etiological origin of uveitis. Anterior chamber paracentesis was performed in all patients presenting with a high suspicion of viral infection. Polymerase chain reaction (PCR) evaluation of the aqueous samples was performed in all cases. After viral confirmation, patients were treated with acyclovir, foscarnet or interferon alpha (3 millions units subcutaneously, thrice a week) associated with topical corticosteroids. Results: Viral uveitis was confirmed in 46 patients during this period. PCR showed the presence of EBV–DNA in 3 cases (6.5%). They all presented as viral–like, granulomatous, hypertensive, strictly anterior or intermediate chronic uveitis. Intraocular inflammation was bilateral in 2 cases and unilateral in one case. One patient was HIV–positive. Furthermore, we have excluded two false–positive results. Acyclovir failed to control ocular inflammation in all cases. High levels of corticodependence were noticed in 2 cases. Interferon–alpha was used in one acyclovir–resistant case with good tolerance and efficacy over a period of 6 months. Discussion: EBV–associated uveitis must be considered as a possible etiology of granulomatous uni or bilateral corticosteroid–dependant uveitis. Virological diagnosis is possible using PCR applied to the aqueous humour. False positive results of PCR should be excluded. They could correspond to systemic circulation of viral particles in asymptomatic carriers, presenting with another etiology of uveitis. No efficient therapy against EBV has been documented. Based on its antiviral and immunomodulatory effects, interferon alpha could be a new therapeutic approach for these patients.

Keywords: antiviral drugs • aqueous • corticosteroids