OUTCOMES OF INFECTIOUS PANUVEITIS ASSOCIATED WITH SIMULTANEOUS MULTI-POSITIVE OCULAR FLUID POLYMERASE CHAIN REACTION

• Published in: Retina (Philadelphia, Pa.) Vol. 44; no. 5; p. 909
• Main Authors: Chau, Viet Q, Hinkle, John W, Wu, Chris Y, Pakravan, Parastou, Volante, Vincent, Sengillo, Jesse D, Staropoli, Patrick C, Miller, Darlene, Yannuzzi, Nicolas A, Albini, Thomas A
• Format: Journal Article
• Language: English
• Published: United States 01.05.2024
• Subjects: Adult; Aged; Aqueous Humor - virology; Cytomegalovirus - genetics; Cytomegalovirus - isolation & purification; DNA, Viral - analysis; Eye Infections, Viral - diagnosis; Eye Infections, Viral - virology; Female; Humans; Male; Middle Aged; Panuveitis - diagnosis; Panuveitis - drug therapy; Panuveitis - virology; Polymerase Chain Reaction; Retrospective Studies; Toxoplasma - genetics; Toxoplasma - isolation & purification; Visual Acuity; Vitreous Body - virology; Young Adult
• ISSN: 1539-2864
• DOI: 10.1097/IAE.0000000000004037

To evaluate features of infectious panuveitis associated with multiple pathogens detected by ocular fluid sampling. Single-center, retrospective, consecutive case series of patients with aqueous/vitreous polymerase chain reaction testing with >1 positive result in a single sample from 2001 to 2021. Of 1,588 polymerase chain reaction samples, 28 (1.76%) were positive for two pathogens. Most common pathogens were cytomegalovirus (n = 16, 57.1%) and Epstein-Barr virus (n = 13, 46.4%), followed by varicella zoster virus (n = 8, 28.6%), Toxoplasma gondii (n = 6, 21.4%), herpes simplex virus 2 (n = 6, 21.4%), herpes simplex virus 1 (n = 6, 21.4%), and Toxocara (n = 1, 3.6%). Mean initial and final visual acuity (logarithm of the minimum angle of resolution) were 1.3 ± 0.9 (Snellen ∼20/400) and 1.3 ± 1.1 (Snellen ∼20/400), respectively. Cytomegalovirus-positive eyes (n = 16, 61.5%) had a mean final visual acuity of 0.94 ± 1.1 (Snellen ∼20/175), whereas cytomegalovirus-negative eyes (n = 10, 38%) had a final visual acuity of 1.82 ± 1.0 (Snellen ∼20/1,320) ( P < 0.05). Main clinical features included intraocular inflammation (100%), retinal whitening (84.6%), immunosuppression (65.4%), retinal hemorrhage (38.5%), and retinal detachment (34.6%). Cytomegalovirus or Epstein-Barr virus were common unique pathogens identified in multi-PCR-positive samples. Most patients with co-infection were immunosuppressed with a high rate of retinal detachment and poor final visual acuity. Cytomegalovirus-positive eyes had better visual outcomes compared with cytomegalovirus-negative eyes.