Clinical Features of Cytomegalovirus Anterior Uveitis in Immunocompetent Patients

• Published in: American journal of ophthalmology Vol. 145; no. 5; pp. 834 - 840.e1
• Main Authors: Chee, Soon-Phaik, Bacsal, Kristine, Jap, Aliza, Se-Thoe, Su-Yun, Cheng, Ching Li, Tan, Ban Hock
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2008; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Antiviral Agents - therapeutic use; Aqueous Humor - virology; Biological and medical sciences; Cytomegalovirus; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - virology; DNA, Viral - analysis; Eye Infections, Viral - diagnosis; Eye Infections, Viral - drug therapy; Eye Infections, Viral - virology; Female; Ganciclovir - therapeutic use; Glaucoma; Humans; Immunocompetence; Infectious diseases; Intraocular Pressure; Iridocyclitis - diagnosis; Iridocyclitis - drug therapy; Iridocyclitis - virology; Laboratories; Male; Medical sciences; Medical treatment; Middle Aged; Miscellaneous; Ocular Hypertension - diagnosis; Ocular Hypertension - drug therapy; Ocular Hypertension - virology; Ophthalmology; Polymerase Chain Reaction; Recurrence; Retrospective Studies; Syndrome; Uvea diseases; Viral diseases; Infection; Virus; Human; Symptomatology; Eye disease; Herpesviridae; Anterior uveitis; Viral disease; Uvea disease; Ophthalmology; Betaherpesvirinae; Human cytomegalovirus
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2007.12.015

To describe the clinical presentation of cytomegalovirus (CMV) anterior uveitis in human immunodeficiency virus (HIV)-negative patients. Retrospective, interventional case series. HIV-negative patients with anterior uveitis associated with elevated intraocular pressure (hypertensive anterior uveitis) seen at the Singapore National Eye Centre had their aqueous analyzed for viral deoxyribonucleic acid by polymerase chain reaction, and their records were reviewed for demographic data, ocular findings, laboratory results, and treatment. Aqueous was obtained from 105 of 106 eligible eyes. Twenty-four eyes demonstrated positive results for CMV (22.8%). Eighteen eyes had Posner-Schlossman syndrome (PSS; 75%) at presentation, five eyesba had Fuchs heterochromic iridocyclitis (FHI; 20.8%), and one eye had a presumed herpetic anterior uveitis. Twelve of the 24 eyes were treated with ganciclovir. Of the 12 who completed treatment, all responded clinically, and their aqueous demonstrated negative results for CMV on repeat testing. However, nine had recurrences within eight months of stopping treatment and required further courses of ganciclovir. The 81 CMV-negative eyes included 30 with PSS, 11 with FHI, 27 with uveitic glaucomas of unknown cause, and 13 with presumed herpetic anterior uveitis. CMV anterior uveitis is not uncommon in our immunocompetent patients and it may present as a recurrent acute or chronic inflammation, resembling PSS, herpetic anterior uveitis, or FHI.