The Use of PCR for Diagnosis of Atypical VZV Ocular Diseases

Abstract

Abstract: : Purpose: Varicella zoster virus (VZV) is a herpesvirus that can manifest as either a primary infection or latent reactivation. In the ocular system, VZV has many different presentations that can affect both anterior and posterior segments. Typically, the diagnosis of VZV infection has been based on clinical judgment alone, without laboratory confirmatory testing. In this study, we compared the positive results of VZV polymerase chain reaction (PCR) with clinical diagnosis and evaluated if test results altered clinical management. Methods: A retrospective chart review was performed on eight positive VZV PCR results over the past 12 months. Results: Four of eight positive results were confirmatory of clinically suspected VZV and did not alter management. However, the other four positive cases definitely diagnosed active infection in cases that were clinically atypical and resulted in a modification of therapy. Conclusion: The diagnosis of ocular VZV is usually made clinically with classic signs and symptoms. Occasionally, VZV may present in an atypical manner. PCR results can be either confirmatory or clinch the diagnosis, thus directing therapeutic management. In atypical cases, PCR may be a simple diagnostic test that can positively alter management.

Keywords: varicella zoster virus • herpes simplex virus