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Eri Matsumoto, Kazuichi Maruyama, Yoshinori Oie, Takeshi Soma, Noriyasu Hashida, Motokazu Tsujikawa, Kohji Nishida; The effect of PCR testing on the clinical course in herpetic uveitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):820.
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Polymerase chain reaction (PCR) is often used to diagnose ocular infections. However, some cases cannot be diagnosed, even with PCR. Here, we examined the use of multiplex PCR (mPCR) for the diagnosis of iridocyclitis, especially cytomegalovirus (CMV) induced iridocyclitis, as well as its treatment course and prognosis.
This study was a retrospective review of the clinical charts of 25 patients who were clinically diagnosed with CMV infection and underwent PCR testing of the aqueous humor between April 2017 and September 2018. All patients were examined with mPCR, and positive cases also underwent real-time PCR to measure the virus copy number. Finally, the clinical course of all patients was assessed and corneal endothelial cell (CEC) density was measured and compared in CMV DNA-positive and negative groups.
Ten of 25 patients (40%) who were clinically diagnosed with CMV-induced iridocyclitis had positive results in mPCR testing. Most of these patients also showed a high copy number of CMV DNA in real-time PCR testing. Fifteen of 25 patients (60%) showed negative results in mPCR testing. Four of 25 patients (16%) underwent surgical intervention among the mPCR positive cases, vs. 13 of 25 (52%) among the negative cases. CEC density was strongly reduced in the negative cases (347 cells/mm2) compared with the mPCR positive cases (1950 cells/mm2) (p<0.001).
Among clinical cases suspected of CMV iridocyclitis, those that were negative for CMV DNA more often received surgical treatment, and experienced more strongly reduced CEC density. Conversely, cases that were positive for CMV DNA were diagnosed earlier and received appropriate drug treatment. This may have avoided the need for surgical intervention while also maintaining CEC density.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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