Original article
Clinical Features of Cytomegalovirus Anterior Uveitis in Immunocompetent Patients

https://doi.org/10.1016/j.ajo.2007.12.015Get rights and content

Purpose

To describe the clinical presentation of cytomegalovirus (CMV) anterior uveitis in human immunodeficiency virus (HIV)-negative patients.

Design

Retrospective, interventional case series.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Methods

This was a retrospective review of patients with hypertensive anterior uveitis who were investigated and managed according to a standard protocol. All patients seen at the Uveitis Clinic of the Singapore National Eye Centre from January 2004 through December 2006 with hypertensive anterior uveitis had their aqueous analyzed for viral deoxyribonucleic acid (DNA) after giving informed consent. Where indicated, they also underwent full blood count analysis, erythrocyte sedimentation rate analysis,

Results

One hundred and four patients were seen during the study period who were eligible for inclusion. Two patients had bilateral involvement. All the patients consented to AC taps, and 105 eyes were tapped. The only eligible eye that did not have aqueous sampling was the second eye of a patient with bilateral simultaneous FHI, and only the more severely affected eye was tapped. In the other patient with bilateral involvement, the second eye was examined and determined to require treatment eight

Discussion

Viruses are increasingly being implicated as a cause of what previously had been considered to be idiopathic ocular inflammations, even in immunocompetent patients. CMV, HSV, VZV, and mumps viruses have been associated with corneal endotheliitis,3, 9, 13, 14, 15 HSV and CMV have been associated with PSS,4, 5, 16 and rubella and HSV have been associated with FHI.17, 18, 19

We found CMV DNA on Tetraplex PCR in 24 (22.8%) of our eyes with hypertensive anterior uveitis, 14 of which also had positive

Soon-Phaik Chee graduated from the National University of Singapore and became a Fellow of the Royal College of Ophthalmologists in 1990. She did her Ocular Inflammation Fellowship in Moorfields Eye Hospital, London, United Kingdom. Dr Chee is currently the Senior Consultant and Head of the Ocular Inflammation and Immunology Service at the Singapore National Eye Centre, and is an Associate Professor of the Department of Ophthalmology at Yong Loo Lin School of Medicine, National University of

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  • S.B. Teoh et al.

    Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction

    Eye

    (2005)
  • Cited by (0)

    Soon-Phaik Chee graduated from the National University of Singapore and became a Fellow of the Royal College of Ophthalmologists in 1990. She did her Ocular Inflammation Fellowship in Moorfields Eye Hospital, London, United Kingdom. Dr Chee is currently the Senior Consultant and Head of the Ocular Inflammation and Immunology Service at the Singapore National Eye Centre, and is an Associate Professor of the Department of Ophthalmology at Yong Loo Lin School of Medicine, National University of Singapore.

    See accompanying Editorial on page 769.

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