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Interlandi E, Cimino L, Accorinti M, Miserocchi E, Latanza L, Allegri P, Mora P, Fonollosa A, Adan A, Pavesio C, De Marco R, Gandolfi SA, Nucci P, De Luca M, Gozzi F, Visioli G, Rissotto F, Rissotto R, Bellucci C, Cachero JM, Pellegrini F, Li Calzi G, Sainz de la Maza M, Cirillo P, Mastrofilippo V, Sacchi M. Posner-Schlossman Syndrome European Study Group: study protocol and baseline patients characteristics of a multicentre study. Br J Ophthalmol 2024:bjo-2023-324900. [PMID: 38811053 DOI: 10.1136/bjo-2023-324900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The aim of the Posner-Schlossman Syndrome European Study Group (PSS-ESG) is to acquire a comprehensive dataset of European patients with PSS. Here, we present the first report on the study protocol and the clinical findings of the patients at baseline. METHODS The PSS-ESG is a retrospective, multicentre study designed to evaluate patients with PSS. The study, designed and driven by a European Expert Committee includes three datasets: (1) the baseline, (2) the follow-up and (3) the intraocular pressure (IOP)/glaucoma dataset. RESULTS A total of 11 centres adhered to the PSS-ESG and 107 patients were included (68 males, 39 females) mostly Caucasian (93.4%). At uveitis onset, the patient's age ranged between 11 and 76 years, (mean age: 42±15 years).Best-corrected visual acuity was >0.5 in 80.3% of the eyes, IOP was >40 mm Hg in 44% of the eyes. Keratic precipitates were found in 78.5% of the eyes. No flare or cells in anterior chamber were detected in 56% and 53% of the cases, respectively. PCR analysis on aqueous sample was positive for cytomegalovirus-DNA in 50.6% out of the 81 tested patients. CONCLUSIONS The PSS-ESG is the first multicentre study aimed to collect a comprehensive dataset of patients with PSS in non-Asian countries. A middlde-aged Caucasian male with a low-grade anterior chamber inflammation, keratic precipitates, preserved visual acuity and marked increased in IOP seemed to be the standard PSS patient across the 11 uveitis and glaucoma centres participating in the PSS-ESG.
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Affiliation(s)
- Emanuela Interlandi
- Uveitis Center, Department of Ophthalmology, Ospedale del Mare, ASL Napoli 1-centro, Naples, Italy
- Uveitis Center, Centro Uveiti Napoli, Naples, Italy
| | - Luca Cimino
- Surgery, Medicine, Dentistry and Morphological Science with interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Accorinti
- Ocular Immunovirology Service, Department of Ophthalmology, University of Rome La Sapienza, Rome, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, Università Vita e Salute, Milan, Italy
| | | | - Pia Allegri
- Ocular Inflammatory Diseases Referral Center, Rapallo Hospital, Rapallo, Italy
| | - Paolo Mora
- Ophthalmology, University of Parma, Parma, Italy
| | - Alex Fonollosa
- Ophthalmology, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Alfredo Adan
- Ophthalmology Department, Institut Clinic de Barcelona, Autonoma University, Barcelona, Spain
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Rocco De Marco
- Uveitis Center, Department of Ophthalmology, Ospedale del Mare, ASL Napoli 1-centro, Naples, Italy
| | | | - Paolo Nucci
- Ophthalmology, University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Marco De Luca
- Uveitis Center, Department of Ophthalmology, Ospedale del Mare, ASL Napoli 1-centro, Naples, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giacomo Visioli
- Ocular Immunovirology Service, Department of Ophthalmology, University of Rome La Sapienza, Rome, Italy
| | - Federico Rissotto
- Department of Ophthalmology, San Raffaele Scientific Institute, Università Vita e Salute, Milan, Italy
| | - Roberta Rissotto
- Ocular Inflammatory Diseases Referral Center, Rapallo Hospital, Rapallo, Italy
| | | | - Josè Manuel Cachero
- Ophthalmology, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | | | - Gaia Li Calzi
- Ophthalmology, University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Maite Sainz de la Maza
- Ophthalmology Department, Institut Clinic de Barcelona, Autonoma University, Barcelona, Spain
| | - Pasquale Cirillo
- Uveitis Center, Department of Ophthalmology, Ospedale del Mare, ASL Napoli 1-centro, Naples, Italy
| | | | - Matteo Sacchi
- Ophthalmology, University of Sassari, Sassari, Italy
- Ophthalmology, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
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Dheyab AM, Albloushi AF, Al-Zuabi A, AlTariqi SM, Tobaigy MF, Alfawaz A, Abu El-Asrar A. Long-term Efficacy of Oral Valganciclovir in Presumed Cytomegalovirus Unilateral Hypertensive Anterior Uveitis. Ocul Immunol Inflamm 2024:1-8. [PMID: 38776468 DOI: 10.1080/09273948.2024.2356057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To describe long-term efficacy and safety of oral valganciclovir in the treatment of presumed cytomegalovirus (CMV) unilateral hypertensive anterior uveitis. METHODS Retrospective review of 40 patients (40 eyes). RESULTS All patients presented with high intraocular pressure (mean 39.35 ± 7.58 mmHg), associated with signs of mild anterior uveitis. Oral valganciclovir resulted in control of the intraocular pressures and inflammation in 35 eyes. At the dose of ≥450 mg twice daily, no relapses were documented. The follow-up period ranged from 12 to 108 months (24.45 ± 14.56). At the final follow-up, the intraocular pressure was reduced to 14.92 ± 2.43 mmHg (<0.001). Drug-related complications in the form of leukopenia and azoospermia were reported in one patient. CONCLUSIONS Oral valganciclovir effectively and safely controls intraocular pressure and inflammation in presumed CMV anterior uveitis. A long-term treatment course seems necessary.
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Affiliation(s)
- Abdulsalam M Dheyab
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman F Albloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asma Al-Zuabi
- Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sulaiman M AlTariqi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohannad F Tobaigy
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alfawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Maier AKB, Mandrossa D, Reitemeyer E, Winterhalter S, Rübsam A, Pleyer U. Viral Anterior Uveitis: Differences in Retinal Vessel Area Density between the Affected and Non-Affected Eye Using Optical Coherence Tomography Angiography. Ocul Immunol Inflamm 2024:1-9. [PMID: 38517389 DOI: 10.1080/09273948.2024.2329318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To investigate differences in the retinal vessel area density (VAD) on optical coherence tomography angiography (OCTA) between eyes with unilateral herpetic viral anterior uveitis (VAU) (herpes-simplex virus (HSV) and varicella-zoster virus (VZV)) and the non-affected fellow eye. METHODS In this monocentric, observational, prospective case series we analyzed the VAD of the macula, optic disc, and peripapillary region in affected and non-affected eyes of 22 patients with HSV-positive and 22 patients with VZV-positive VAU using OCTA. We analyzed also the visual field mean deviation (MD), the retinal nerve fiber layer (RNFL) thickness, Bruch's Membrane Opening-Minimum Rim Width (BMO-MRW), and ganglion cell layer (GCL) thickness on OCT and correlated the results with the different VADs. RESULTS The macular VAD in the superficial vascular plexus (SVC) was significant lower in the affected compared to the non-affected eye for both viruses (HSV: 33.0% ± 3.3% vs. 34.7% ± 2.6%, p = 0.011; adjusted p = 0.040; VZV: 33.1% ± 3.2% vs. 34.3% ± 2.8%, p = 0.012; adjusted p = 0.050). Additionally, the VAD of the peripapillary SVC differed between the affected and non-affected eye for VZV-positive VAU (47.1% ± 6.2% vs. 50.5% ± 6.3%, p = 0.048, adjusted p = 0.100). For both HSV-positive and VZV-positive VAU, there were correlations between macular or peripapillary SVC VAD and BMO-MRW, GCL thickness, RNFL thickness or MD of the affected eye. CONCLUSION We observed vascular dysfunction characterized by decreased macular and peripapillary VAD in the superficial plexus on OCTA in eyes with HSV- and VZV-positive VAU compared to non-affected fellow eyes. These changes might be an early sign of glaucomatous damage or may be a direct consequence of the herpes viruses themselves.
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Affiliation(s)
- Anna-Karina B Maier
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Mandrossa
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anne Rübsam
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Yoo WS, Kwon LH, Eom Y, Thng ZX, Or C, Nguyen QD, Kim SJ. Cytomegalovirus Corneal Endotheliitis: A Comprehensive Review. Ocul Immunol Inflamm 2024:1-10. [PMID: 38417101 DOI: 10.1080/09273948.2024.2320704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024]
Abstract
Cytomegalovirus (CMV) anterior uveitis and corneal endotheliitis are the most common ocular diseases caused by CMV infections in immunocompetent patients. The incidence of CMV corneal endotheliitis is relatively high in middle-aged men. CMV corneal endotheliitis presents with mild anterior chamber inflammation, corneal edema, keratic precipitates, and elevated intraocular pressure. It resembles Posner-Schlossman syndrome and Fuchs uveitis because of the elevated intraocular pressure. Without proper diagnosis and treatment, it may progress to bullous keratopathy or glaucoma, necessitating keratoplasty or glaucoma surgery. Therefore, early diagnosis and treatment are important for a good prognosis. Aqueous humor analysis can facilitate the diagnosis of CMV corneal endotheliitis, and early antiviral treatment can decrease the risk of corneal compensation or glaucomatous optic atrophy. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of CMV corneal endotheliitis along with the evidence for early clinical diagnosis and active antiviral treatment.
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Affiliation(s)
- Woong-Sun Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lee-Ha Kwon
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Zheng Xian Thng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Halkiadakis I, Konstantopoulou K, Tzimis V, Papadopoulos N, Chatzistefanou K, Markomichelakis NN. Update on Diagnosis and Treatment of Uveitic Glaucoma. J Clin Med 2024; 13:1185. [PMID: 38592059 PMCID: PMC10931771 DOI: 10.3390/jcm13051185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG.
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Affiliation(s)
- Ioannis Halkiadakis
- Ophthalmiatrion Athinon, Athens Eye Hospital, 10672 Athens, Greece; (K.K.); (V.T.); (N.P.)
| | | | - Vasilios Tzimis
- Ophthalmiatrion Athinon, Athens Eye Hospital, 10672 Athens, Greece; (K.K.); (V.T.); (N.P.)
| | - Nikolaos Papadopoulos
- Ophthalmiatrion Athinon, Athens Eye Hospital, 10672 Athens, Greece; (K.K.); (V.T.); (N.P.)
| | - Klio Chatzistefanou
- First Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens General Hospital “G. Gennimatas”, 11527 Athenbs, Greece;
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Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2-global current practice patterns for the management of Cytomegalovirus anterior uveitis. Eye (Lond) 2024; 38:68-75. [PMID: 37419958 PMCID: PMC10764804 DOI: 10.1038/s41433-023-02631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS To present current practice patterns in the diagnosis and management of Cytomegalovirus anterior uveitis (CMV AU) by uveitis experts worldwide. METHODS A two-round modified Delphi survey with masking of the study team was performed. Based on experience and expertise, 100 international uveitis specialists from 21 countries were invited to participate in the survey. Variation in the diagnostic approaches and preferred management of CMV AU was captured using an online survey platform. RESULTS Seventy-five experts completed both surveys. Fifty-five of the 75 experts (73.3%) would always perform diagnostic aqueous tap in suspected CMV AU cases. Consensus was achieved for starting topical antiviral treatment (85% of experts). About half of the experts (48%) would only commence systemic antiviral treatment for severe, prolonged, or atypical presentation. The preferred specific route was ganciclovir gel 0.15% for topical treatment (selected by 70% of experts) and oral valganciclovir for systemic treatment (78% of experts). The majority of experts (77%) would commence treatment with topical corticosteroid four times daily for one to two weeks along with antiviral coverage, with subsequent adjustment depending on the clinical response. Prednisolone acetate 1% was the drug of choice (opted by 70% of experts). Long-term maintenance treatment (up to 12 months) can be considered for chronic course of inflammation (88% of experts) and those with at least 2 episodes of CMV AU within a year (75-88% of experts). CONCLUSIONS Preferred management practices for CMV AU vary widely. Further research is necessary to refine diagnosis and management and provide higher-level evidence.
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Affiliation(s)
- Zheng Xian Thng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Kevin Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Westcott
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew D Dick
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
- UCL-Institute of Ophthalmology, London, UK
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Addis Ababa University Department of Ophthalmology, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Bahram Bodaghi
- Dept of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l'Hopital, 75013, Paris, France
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talin Barisani-Asenbauer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marc D de Smet
- Dept of Ophthalmology, Leiden University, Leiden, Netherlands
- MIOS sa, Lausanne, Switzerland
| | - Justine R Smith
- Flinders University College of Medicine & Public Health, Adelaide, Australia and Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Director Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldstein
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James T Rosenbaum
- Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Palo Alto, CA, USA
| | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- UCL-Institute of Ophthalmology, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Chiang WY, Chen SC, Sheu SJ, Kuo HK. A Prospective Study of Clinical Features of Anterior Uveitis in Taiwan. J Ophthalmol 2023; 2023:9647418. [PMID: 38025927 PMCID: PMC10645496 DOI: 10.1155/2023/9647418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/25/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
In this study, we reported the patterns, epidemiology, and clinical features of anterior uveitis (AU) in Taiwan, an area of Eastern Asia. This prospective, cross-sectional case series study was performed to identify patients with AU at two tertiary medical centers (Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital) located at the southern Taiwan between December 1, 2018, and March 31, 2020. The clinical diagnoses, ocular presentations, and laboratory data, including the results of the aqueous polymerase chain reaction tests, were investigated in these patients. A total of 112 patients, with a mean age of 48.9 years, were included. Most patients (87.5%) presented with unilateral eye disease, with 30 cases of ocular hypertension at the first presentation (27%). The most common clinical diagnoses were idiopathic AU (37.5%), human leukocyte antigen (HLA)-B27-associated acute AU (25.0%), and herpetic AU (18.8%). Among patients with herpetic AU, cytomegalovirus (CMV) was the most common pathogen (17/21, 81%). Compared to HLA-B27-associated acute AU, CMV-related AU was mostly observed in patients that were older in age, exhibited higher intraocular pressure, more keratic precipitates, greater iris atrophy, and more pseudophakia, but was least reported in those with posterior synechiae. This prospective study identified the pattern and clinical features of AU in southern Taiwan.
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Affiliation(s)
- Wei-Yu Chiang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Shih-Chou Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
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8
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Hülse P, Reitemeyer E, Rübsam A, Pleyer U, Maier AKB. Cytomegalovirus-positive Posner-Schlossman syndrome: to compare differences in retinal vessel area density between the affected and non-affected eye using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2023; 261:3263-3274. [PMID: 37480544 PMCID: PMC10587322 DOI: 10.1007/s00417-023-06171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE To analyse differences in the retinal microvasculature in eyes with cytomegalovirus (CMV)-positive Posner-Schlossman syndrome (PSS) compared to the non-affected eyes using optical coherence tomography angiography (OCTA). METHODS In this monocentric, observational prospective case series, 25 patients with unilateral CMV-positive PSS were included. We compared the vessel area densities (VAD) in the macula, optic disc, and peripapillary region in PSS-affected and non-affected eyes using OCTA. We compared the visual fields (VF) of the affected and healthy eyes of each patient. The mean deviation (MD) of the VF was analysed together with the retinal nerve fibre layer (RNFL) thickness to evaluate the strength of correlation with the VAD parameters. RESULTS The VAD of the peripapillary superficial vascular complex (SVC) is significantly reduced in CMV-positive PSS-affected eyes (46.1 ± 9.3% versus 50.1 ± 6.3%, p = 0.008, adjusted p = 0.048). The VAD of the deeper macular, papillary, and peripapillary layers showed no differences between the affected and non-affected eyes. The mean deviation and the retinal nerve fibre layer thickness had correlations with the VAD of the macula (r = 0.451, p = 0.001, r = 0.553, p < 0.001), the peripapillary SCV (r = 0.430, p = 0.002, r = 0.723, p < 0.001), and the papillary region (r = 0.512, p < 0.001, r = 0.292, p = 0.039). Patients receiving systemic antiviral therapy (SAT) showed better VAD of the peripapillary choriocapillary layer (p = 0.001, no therapy: 31.4 ± 1.9%, SAT: 35.0 ± 1.6%), and choroidal layer (p = 0.009, no therapy: 34.2 ± 0.3%, SAT: 36.3 ± 1.8%) compared to those with no SAT. CONCLUSION A lower peripapillary VAD in the SVC might indicate vascular dysfunction as a sign of glaucomatous damage. SAT might have positive effects on the microcirculation in the deep retinal and choroidal layers. TRIAL REGISTRATION TRN: DRKS00028266, https://www.drks.de/drks_web/ .
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Affiliation(s)
- Patricia Hülse
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne Rübsam
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna-Karina B Maier
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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9
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Feng Y, Garcia R, Rojas-Carabali W, Cifuentes-González C, Putera I, Li J, La Distia Nora R, Mahendradas P, Gupta V, de-la-Torre A, Agrawal R. Viral Anterior Uveitis: A Practical and Comprehensive Review of Diagnosis and Treatment. Ocul Immunol Inflamm 2023:1-15. [PMID: 37862684 DOI: 10.1080/09273948.2023.2271077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
Anterior uveitis is the most common type of uveitis worldwide. The etiologies of anterior uveitis can be divided into infectious and non-infectious (idiopathic, autoimmune, autoinflammatory, trauma, and others). The viral pathogens most commonly associated with infectious anterior uveitis include Herpes Simplex Virus, Varicella-Zoster Virus, Cytomegalovirus, and Rubella Virus. Other emerging causes of viral anterior uveitis are West Nile Virus, Human-Immunodeficiency Virus, Epstein-Barr Virus, Parechovirus, Dengue Virus, Chikungunya Virus, and Human Herpesvirus type 6,7, and 8. Early recognition allows prompt management and mitigates its potential ocular complications. This article provides an updated literature review of the epidemiology, clinical manifestations, diagnostic tools, and treatment options for viral anterior uveitis.
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Affiliation(s)
- Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Eye Center, Peking University Third Hospital, Beijing, China
| | - Ruby Garcia
- Reno School of Medicine, University of Nevada, Reno, Nebraska, USA
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jingyi Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Eye Center, Peking University Third Hospital, Beijing, China
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | | | - Vishali Gupta
- Advanced Eye Centre, Post- Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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10
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Morel A, Debieb AC, Mrejen D, Amrouche L, Scemla A, Vilain E, Legendre C, Anglicheau D, Zuber J, Brézin A, Chavarot N. CMV-related anterior and intermediate uveitis in a kidney transplant recipient treated with belatacept. Eur J Ophthalmol 2023; 33:NP47-NP50. [PMID: 36112857 DOI: 10.1177/11206721221126308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Belatacept is associated with a higher incidence of cytomegalovirus (CMV) disease and atypical presentations. Ocular manifestations are rare, representing up to 5% of disease manifestations and previous cases consisted in isolated retinitis. CASE DESCRIPTION Herein, we report the case of an 81-year-old kidney transplant recipient who developed an anterior and intermediate uveitis under belatacept therapy. The diagnosis was established using quantitative CMV polymerase chain reaction assays in the aqueous humor. Belatacept was interrupted and oral and topical valganciclovir treatments were instituted. Lesions however extended, leading to intensify the treatment by intra-venous and intra-vitreal ganciclovir injections. Visual acuity stabilized and ocular inflammation was finally controlled after 3 months. CONCLUSION Clinicians should be aware of CMV infection as a cause of anterior uveitis under belatacept-based regimen, even in the absence of symptoms suggestive of systemic CMV replication.
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Affiliation(s)
- Antoine Morel
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Amina Chahrazed Debieb
- Université de Paris, Paris, France
- Department of Ophthalmology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Mrejen
- Université de Paris, Paris, France
- Department of Ophthalmology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Estelle Vilain
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Antoine Brézin
- Université de Paris, Paris, France
- Department of Ophthalmology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
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11
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Chiang WY, Lin CP, Cho WH, Yang CH, Chen SN, Hwang YS, Hsu SM, Hwang DK, Chen SC, Kuo HK, Sheu SJ. Cytomegalovirus Uveitis: Taiwan expert consensus. J Formos Med Assoc 2023; 122:668-674. [PMID: 37003913 DOI: 10.1016/j.jfma.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Cytomegalovirus (CMV) uveitis, a type of herpetic uveitis, is a major cause of infectious uveitis. Anterior and posterior CMV uveitis have diverse clinical presentations and treatment modalities. Based on expert consensus in Taiwan, this article provides suggestions regarding clinical manifestations, diagnosis, and treatment strategies for CMV uveitis based on clinical practice experience in Taiwan. CMV uveitis may have a distinct clinical presentation. Polymerase chain reaction (PCR) is an essential diagnostic tool to confirm a diagnosis. Antiviral therapy is the mainstay of treatment. Different agents, routes, and other supplemental treatments have been summarized and discussed in this article. Early diagnosis and appropriate treatment of CMV uveitis are crucial to avoid irreversible complications and vision loss. This consensus provides practical guidelines for ophthalmologists in Taiwan.
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Affiliation(s)
- Wei-Yu Chiang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Hua Cho
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Yih-Shiou Hwang
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chou Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan.
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12
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Sheng Q, Sun Y, Zhai R, Fan X, Ying Y, Kong X. 2% Ganciclovir Controlled Posner-Schlossman Syndrome Relapse and Reduced the Chance of Corticosteroid Dependence: A Large Cohort in East China. Ocul Immunol Inflamm 2023:1-8. [PMID: 37437131 DOI: 10.1080/09273948.2023.2228404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To present the process from acute Posner-Schlossman syndrome (PSS) relapse to remission under 2% ganciclovir (GCV), corticosteroids and anti-glaucoma agents on 323 patients. METHODS A retrospective study enrolling 323 PSS patients. Demographics and ophthalmic examination results were generated. Patients were treated with GCV, corticosteroids and anti-glaucoma agents andfollowed up every 2-6 weeks. RESULTS Patients were divided into the GCV monotherapy (N = 65, 20.12%), GCV and corticosteroids (G+C, N = 106) and GCV, corticosteroid and IOP-lowering drugs (G+C+L, N = 152) group. The G+C+L group had the highest intraocular pressure (IOP, 26.33 ± 10.26 mmHg, P < 0.001) and largest cup-to-disc ratio (0.58 ± 0.19, P < 0.05). After treatment, IOP of three groups dropped to similar level. Ninety-nine (30.65%) patients were corticosteroid-dependent whose daily corticosteroid consumption decreased after using GCV (from 2.23 ± 1.02 to 0.97 ± 0.98 drops/day). CONCLUSION 2% GCV solutions worked effectively on PSS relapse with corticosteroids and anti-glaucoma agents. In patients suspected of CMV infection, proper GCV could reduce the chance of corticosteroid dependence.
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Affiliation(s)
- Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Yanan Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Yue Ying
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
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13
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Diaz-Decaro J, Myers E, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Schmidt E, Natenshon A, Talarico C, Buck PO. A systematic literature review of the economic and healthcare resource burden of cytomegalovirus. Curr Med Res Opin 2023; 39:973-986. [PMID: 37395088 DOI: 10.1080/03007995.2023.2222583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) can infect individuals at any age, including infants, who may contract it from infected mothers (congenital CMV [cCMV]). Whereas CMV infection is typically asymptomatic or causes mild illness in healthy individuals, infection can result in severe outcomes in immunocompromised individuals and in infants with cCMV. This systematic review aims to characterize the economic impact of CMV and cCMV infections. METHODS Medline, Embase, and LILACS databases were searched for publications reporting the economic impact of cCMV and CMV infections across all age groups. Manuscripts published between 2010 and 2020 from Australia, Latin America, Canada, Europe, Israel, Japan, the United States, and global (international, worldwide) studies were included; congress materials were excluded. Outcomes of interest included cCMV- and CMV-attributable direct costs/charges, resource utilization, and indirect/societal costs. RESULTS Of 751 records identified, 518 were excluded based on duplication, population, outcome, study design, or country. Overall, 55 articles were eligible for full-text review; 25 were further excluded due to population, outcome, study design, or congress abstract. Two publications were additionally identified, resulting in economic impact data compiled from 32 publications. Of these, 24 publications reported cost studies of cCMV or CMV, including evaluation of direct costs/charges, healthcare resource utilization, and indirect/societal costs, and 7 publications reported economic evaluations of interventions. The populations, methods and outcomes used across these studies varied widely. CONCLUSIONS CMV and cCMV infections impose a considerable economic impact on different countries, populations, and outcomes. There are substantial evidence gaps where further research is warranted.
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Affiliation(s)
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
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14
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Huang CY, Cheng YC, Hwang YS, Kang EYC, Hsiao CH. Cytomegalovirus Glycoprotein B Genotype in Patients with Anterior Segment Infection. Int J Mol Sci 2023; 24:ijms24076304. [PMID: 37047276 PMCID: PMC10094332 DOI: 10.3390/ijms24076304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
(1) The glycoprotein B (gB) on the viral envelope, encoded by the most widely characterised polymorphic gene, gpUL55, is responsible for cytomegalovirus (CMV) entry into the host and could serve as a potential marker of pathogenicity. The aim of the present study is to investigate the distribution of the CMV gB genotype in anterior segment infection in Taiwan and its correlation with clinical manifestations and outcomes. (2) Fifty-seven patients with CMV anterior segment infection were identified according to clinical features and positivity for CMV DNA in aqueous humour samples. CMV gB genotyping was performed through polymerase chain reaction assays. Patients’ medical records were retrospectively reviewed. (3) Among the 57 aqueous humour samples tested for gB, 40 (70.28%) had multiple gB genotypes, and only 17 (29.82%) had a single gB genotype. Compared with single-genotype infection, multiple-genotype infection was correlated with higher CMV loads (p < 0.001) but not correlated with outcome. A higher proportion of patients with the gB3 genotype had received filtering surgery before antiviral treatment than those without the gB3 genotype (p = 0.046). (4) Multiple-genotype infection was highly prevalent in CMV anterior segment infection in Taiwan, and gB1 and gB3 were predominant. Multiple-genotype infection was correlated with higher CMV loads but not with specific clinical manifestations or prognostic outcomes. The gB3 genotype may be correlated with poor intraocular pressure control.
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15
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Chatzistefanou KI, Halkiadakis I, Maselos S, Markomichelakis NN. Comparison of Clinical Characteristics between Rubella Virus and Cytomegalovirus Associated Chronic Unilateral Anterior Uveitis. Ocul Immunol Inflamm 2023:1-7. [PMID: 36867862 DOI: 10.1080/09273948.2023.2179499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To identify the clinical characteristics that may predict the diagnosis of Rubella virus (RV) or Cytomegalovirus (CMV) among cases of chronic treatment resistant or steroid dependent unilateral anterior uveitis (AU). METHODS Thirty-three consecutive patients with a diagnosis of CMV and 32 patients with RV chronic AU were enrolled. The respective frequency of certain demographic and clinical characteristics was compared between the two groups. RESULTS The presence of abnormal vessels in the anterior chamber angle (75% and 6.1%, respectively, p < .001), vitritis (68.8%-12.1%, p < .001), iris heterochromia (40.6%-15.2%, p = .022) and iris nodules (21.9%-3%, p = .027) were more common among RV AU. Conversely, intraocular pressure greater than 26 mmHg was more commonly encountered in CMV associated AU (63.6%-15.6%, respectively, p < .001) and large keratic precipitates were detected only in CMV-associated AU. CONCLUSIONS RV- and CMV-induced chronic AU differ significantly in the prevalence of specific clinical characteristics.
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Affiliation(s)
- Klio I Chatzistefanou
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | | | - Stelios Maselos
- Uveitis Service, Athens General Hospital "G. Gennimatas", Athens, Greece
- Ocular Inflammation Institute of Athens, Athens, Greece
| | - Nikolaos N Markomichelakis
- Uveitis Service, Athens General Hospital "G. Gennimatas", Athens, Greece
- Ocular Inflammation Institute of Athens, Athens, Greece
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16
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Zhang J, Kamoi K, Zong Y, Yang M, Ohno-Matsui K. Cytomegalovirus Anterior Uveitis: Clinical Manifestations, Diagnosis, Treatment, and Immunological Mechanisms. Viruses 2023; 15:185. [PMID: 36680225 PMCID: PMC9867175 DOI: 10.3390/v15010185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
Little is known regarding anterior uveitis (AU), the most common ocular disease associated with cytomegalovirus (CMV) infection in immunocompetent populations. CMV AU is highly prevalent in Asia, with a higher incidence in men. Clinically, it manifests mainly as anterior chamber inflammation and elevated intraocular pressure (IOP). Acute CMV AU may resemble Posner-Schlossman syndrome with its recurrent hypertensive iritis, while chronic CMV AU may resemble Fuchs uveitis because of its elevated IOP. Without prompt treatment, it may progress to glaucoma; therefore, early diagnosis is critical to prognosis. Knowledge regarding clinical features and aqueous humor analyses can facilitate accurate diagnoses; so, we compared and summarized these aspects. Early antiviral treatment reduces the risk of a glaucoma surgery requirement, and therapeutic effects vary based on drug delivery. Both oral valganciclovir and topical ganciclovir can produce positive clinical outcomes, and higher concentration and frequency are beneficial in chronic CMV retinitis. An extended antiviral course could prevent relapses, but should be limited to 6 months to prevent drug resistance and side effects. In this review, we have systematically summarized the pathogenesis, clinical features, diagnostic and therapeutic aspects, and immunological mechanisms of CMV AU with the goal of providing a theoretical foundation for early clinical diagnosis and treatment.
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Affiliation(s)
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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17
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Ye Z, Yang Y, Ke W, Li Y, Wang K, Chen M. Overview and update on cytomegalovirus-associated anterior uveitis and glaucoma. Front Public Health 2023; 11:1117412. [PMID: 36935679 PMCID: PMC10014866 DOI: 10.3389/fpubh.2023.1117412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/08/2023] [Indexed: 03/06/2023] Open
Abstract
Cytomegalovirus anterior uveitis is the most common ocular inflammatory disease caused by cytomegalovirus infection. It mainly occurs in middle-aged males with competent immunologic function, and the incidence is higher in Asia. The clinical manifestations vary from Posner-Schlossman syndrome and corneal endotheliitis to Fuchs uveitis syndrome, and are often accompanied by intraocular hypertension. Secondary glaucoma is a potentially blinding ocular complication with a pathogenesis that includes complicated immunological factors, intraocular inflammation, different types of angle abnormalities, and the administration of steroids, which may result in physical discomfort and visual impairment. Diagnostic tests, such as the polymerase chain reaction, optical coherence tomography, ocular microscopy, and confocal microscopy, might help in identifying anterior uveitis caused by other viruses. Combinations of antiviral medications and anti-inflammatory agents are effective treatments. If pharmacological therapy cannot reduce intraocular pressure or slow the progression of glaucomatous optic neuropathy, surgical intervention is required as a last resort.
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Affiliation(s)
- Zifan Ye
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yumei Yang
- Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Weishaer Ke
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuhang Li
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
- Kaijun Wang
| | - Min Chen
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
- *Correspondence: Min Chen
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18
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Okazawa R, Iwai S, Nagura K, Sora D, Sato T, Takayama K, Harimoto K, Kanda T, Takeuchi M. Epidemiology and characteristics of common forms of anterior uveitis at initial presentation in a tertiary facility in Japan. Jpn J Ophthalmol 2023; 67:22-31. [PMID: 36346554 DOI: 10.1007/s10384-022-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To elucidate detailed epidemiological profile of common types of anterior uveitis (AU) in real-world clinical setting of a tertiary facility in Japan, and to evaluate the characteristic clinical findings at initial presentation. STUDY DESIGN Retrospective cohort study. METHODS Clinical charts of 275 patients (335 eyes) aged 52.5 ± 19.1 years were reviewed retrospectively. Herpetic AU was diagnosed by multiplex polymerase chain reaction tests using aqueous humor. Time of uveitis onset, gender, laterality, disease course since the initial onset of AU, visual acuity (VA) and intraocular pressure (IOP) at first visit, and definitive diagnosis were collected from clinical charts. RESULTS Acute AU (AAU) was the most common (21.8%) form of AU; followed by herpetic AU (20.7%) comprising Herpes Simplex Virus (HSV) (8.0%), Varicella Zoster Virus (VZV) (9.1%) and cytomegalo virus (CMV) (3.6%); scleritis (13.5%); diabetic iritis (7.6%), and Posner-Schlossman syndrome (5.5%). Unilateral AU constituted 78.2%, and VA less than 20/30 accounted for 31.2%. Of all the eyes, 16.1% had an IOP higher than 20 mmHg, out of which 37.0% had herpetic AU, followed by scleritis in 25.9%, and Posner-Schlossman syndrome (PSS) in 11.1%. AU patients over 60 years of age were 40.4%, in which 34.2% had herpetic AU, followed by scleritis in 14.4% and AAU in 13.5%. Herpetic AU patients were significantly older and had higher IOP compared with AAU patients. CONCLUSION The most frequent AU was AAU, followed by herpetic AU. Herpetic AU patients were older and had higher intraocular pressure than AAU patients, although VA was equally impaired in both groups.
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Affiliation(s)
- Rina Okazawa
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Seima Iwai
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Koichi Nagura
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Daisuke Sora
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Kei Takayama
- Sakura street Takayama Eye Clinic, 4-262-1 Sakuragaoka, Higashiyamato, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan.
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Chien HW, Lee CY, Huang JY, Chen HC, Wang K, Yang SF. The association between late-onset keratitis in congenital cytomegalovirus infection: A nationwide population-based cohort study. Eur J Ophthalmol 2022; 33:11206721221136320. [PMID: 36343960 DOI: 10.1177/11206721221136320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
AIM To estimate the relationship between congenital cytomegalovirus (CMV) infection and late-onset keratitis via use of the National Health Insurance Research Database (NHIRD) of Taiwan. METHODS We yielded this retrospective cohort study and subjects with congenital CMV infection, which according to the diagnostic codes and laboratory exam, were selected as our study group that diagnosed with congenital CMV infection. Each participant in the study group was matched to four individuals without the non-congenital CMV infection by propensity-score matching (PSM) process and the latter served as the control group. The main outcome is the late-onset keratitis that occurs one year after the congenital CMV infection diagnosis. We applied Cox proportional hazard regression to produce the adjusted hazard ratio (HR) and corresponding 95% confidence interval (CI) of late-onset keratitis between two groups. RESULTS There were 426 (7.4%) and 1,516 (6.5%) events of keratitis in the study and control groups. The study group revealed significantly higher ratio of late-onset keratitis than control group after adjusting many confounders (adjusted HR: 1.14, 95% CI: 1.02-1.27), and the cumulative probability of keratitis in the study group was also higher than control group. For the subgroup analysis, the existence of severe congenital CMV infection was significantly correlated to the late-onset keratitis in individuals with congenital CMV infection (adjusted HR: 1.48, 95% CI: 1.01-2.70; P < 0.05). CONCLUSION The congenital CMV infection is related to higher rate of late-onset keratitis, especially for those with severe form.
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Affiliation(s)
- Hsiang-Wen Chien
- Department of Ophthalmology, 60616Cathay General Hospital, Taipei, Taiwan
- Departments of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, 34899Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, Taipei, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, 34899Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai Wang
- Department of Ophthalmology, 60616Cathay General Hospital, Taipei, Taiwan
- Departments of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, 34899Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, 34899Chung Shan Medical University Hospital, Taichung, Taiwan
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20
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Kam KW, Wong CH, Ho M, Sze RKH, Chan PKS, Young AL. Iris Depigmentation in the Prediction of Cytomegalovirus Anterior Uveitis. Ocul Immunol Inflamm 2022; 30:1775-1780. [PMID: 34283680 DOI: 10.1080/09273948.2021.1952277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We hypothesize that the presence of iris depigmentation is associated with the prediction of cytomegalovirus (CMV) as the etiology of chronic or recurrent anterior uveitis. METHODS A prospective cohort study on patients with recurrent or chronic anterior uveitis. Pre-operative data on iris depigmentation and corneal endothelial cell densities were compared between eyes with and without CMV. RESULTS Forty-one eyes of 38 subjects with a mean age of 61.1 ± 11.2 years old were recruited. Seventeen eyes were positive for CMV. A greater proportion of eyes with CMV showed severe or diffuse iris depigmentation than eyes without CMV, and possessed larger corneal endothelial cells (p = .028). When severe iris depigmentation was present with a reduced endothelial cell density, the positive and negative predictive values were raised to 100.0% and 64.9% from 41.5% and 58.5%, respectively. CONCLUSION Iris depigmentation is a potential clinical biomarker in predicting CMV in chronic or recurrent anterior uveitis.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chung Hei Wong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mary Ho
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Ryan Kin Ho Sze
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
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21
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Kuo YW, Chang EC, Lee CY, Lee SH, Liang IC, Chen YC, Hou YC. Effectiveness of Topical Ganciclovir 2% Monotherapy Versus Combined Steroid Therapy in Cytomegalovirus Endotheliitis. J Clin Med 2022; 11:jcm11195811. [PMID: 36233679 PMCID: PMC9572523 DOI: 10.3390/jcm11195811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022] Open
Abstract
We aimed to report the clinical manifestations of cytomegalovirus (CMV) corneal endotheliitis and the results of long-term treatment with topical ganciclovir 2% with and without steroids. This retrospective, interventional study included 15 eyes of 13 patients diagnosed with CMV corneal endotheliitis by positive CMV DNA and treated with long-term topical ganciclovir 2% eye drops at a tertiary referral center and the median follow-up period was 17 months. Ocular manifestations included keratic precipitates (KPs) (100%), elevated IOP (93.3%), iritis (60%), corneal edema (60%), and moth-eaten iris atrophy (60%). After long-term treatment, corneal edema, iritis, and KPs significantly decreased (effect size: 72%, 76% and 70%, respectively; p = 0.024, p = 0.006 and p < 0.001, respectively). Both the logMAR acuity and IOP significantly improved (median logMAR was 0.52 before treatment and 0.22 after treatment; median IOP was 42 mmHg before treatment and 12 mmHg after treatment; p = 0.001 and p < 0.001, respectively). The ECD was maintained (effect size: 80%), and the percentage of hexagonal cell ratio of endothelial cells significantly improved after treatment (effect size: 82%; p = 0.035). Fewer anti-glaucoma medications were used in the non-steroid group (effect size: 79%; p = 0.034). Long-term maintenance treatment with topical ganciclovir 2% monotherapy not only provides effective therapy and reduces recurrence, but also decreases the high IOP related to the combination of steroids used.
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Affiliation(s)
- Yu-Wei Kuo
- Department of Ophthalmology, Cathay General Hospital, Taipei 106438, Taiwan
- Institute of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - En-Che Chang
- Department of Ophthalmology, Cathay General Hospital, Taipei 106438, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
- Nobel Eye Institute, Taipei 100008, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 412224, Taiwan
| | - Shwu-Huey Lee
- Department of Ophthalmology, Cathay General Hospital, Taipei 106438, Taiwan
| | - I-Chia Liang
- Department of Ophthalmology, Cathay General Hospital, Taipei 106438, Taiwan
- Department of Ophthalmology, Tri-Service General Hospital, Taipei 114202, Taiwan
| | - Yi-Chun Chen
- Department of Ophthalmology, Cathay General Hospital, Taipei 106438, Taiwan
| | - Yu-Chih Hou
- Department of Ophthalmology, Cathay General Hospital, Taipei 106438, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100225, Taiwan
- Department of Ophthalmology, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Correspondence: ; Tel.: +886-2-2708-2121 (ext. 8131)
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22
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Wan KH, Liu K, Lam NM, Chow VWS. Outcomes and prognostic factors of cataract surgery in cytomegalovirus-related anterior uveitis. J Cataract Refract Surg 2022; 48:1031-1036. [PMID: 35297811 DOI: 10.1097/j.jcrs.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of cataract surgery in patients with cytomegalovirus (CMV) anterior uveitis and factors associated with final visual outcome. SETTING Hong Kong Eye Hospital, Hong Kong. DESIGN Retrospective case series. METHODS History, clinical characteristics, corrected distance visual acuity (CDVA), medications, and complications of CMV anterior uveitic eyes that underwent cataract surgery between 2010 and 2020 were reviewed. RESULTS This study included 26 eyes of 26 patients undergoing phacoemulsification. The median duration of disease was 4.8 years, and the median quiescent period preoperatively was 2.3 years. None required pupil manipulation or had significant intraoperative complications. The median CDVA improved from 20/100 (interquartile range [IQR] 20/200 to 20/50) preoperatively to 20/30 (IQR 20/40 to 20/25) at 1 year and 20/35 (IQR 20/50 to 20/30) at the last follow-up at a median of 4.9 years postoperatively ( P < .001). CDVA improved in 19 eyes (73.1%) and was ≥20/40 in 18 eyes (69.2%). In the multivariate regression model, preoperative use of topical 0.15% ganciclovir (β = 0.33, 95% CI 0.17 to 0.48, P < .001) and adjunctive intraoperative intracameral dexamethasone 0.4 mg (β = 0.19, 95% CI 0.01 to 0.36, P = .043) were associated with a better final CDVA. Loss of CDVA and poor postoperative CDVA visual acuity were mostly attributed to uveitic glaucoma, but preoperative glaucoma or the number of antiglaucoma medications did not affect final CDVA. CONCLUSIONS Cataract surgery in eyes with CMV anterior uveitis was safe and CDVA significantly improved and remained sustained postoperatively. Topical ganciclovir 0.15% preoperatively and intracameral corticosteroid intraoperatively seem to maximize the final visual outcome.
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Affiliation(s)
- Kelvin H Wan
- From the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Eye Hospital, Kowloon, Hong Kong
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Mori K, Ye Y, Yokogawa H, Nishino T, Kobayashi A, Mori N, Takemoto Y, Sugiyama K. Clinical Features of Glaucoma Associated with Cytomegalovirus Corneal Endotheliitis. Clin Ophthalmol 2022; 16:2705-2711. [PMID: 36017508 PMCID: PMC9397528 DOI: 10.2147/opth.s376039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Kazuya Mori
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yunyan Ye
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hideaki Yokogawa
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Correspondence: Hideaki Yokogawa, Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Takara-machi 13-1, Kanazawa, Ishikawa-ken, 920-8641, Japan, Tel +81-76-265-2403, Fax +81-76-222-9660, Email
| | - Tsubasa Nishino
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Akira Kobayashi
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Natsuko Mori
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yuko Takemoto
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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24
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Lenglinger M, Schick T, Pohlmann D, Pleyer U. Cytomegalovirus-Positive Posner-Schlossman Syndrome: Impact on Corneal Endothelial Cell Loss and Retinal Nerve Fiber Layer Thinning. Am J Ophthalmol 2022; 237:290-298. [PMID: 34998717 DOI: 10.1016/j.ajo.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 11/27/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To report objective morphologic changes in cytomegalovirus (CMV)-positive Posner-Schlossman syndrome (PSS). DESIGN Retrospective, consecutive case series. METHODS We reviewed the charts of patients with unilateral PSS tested positive for CMV by Goldmann-Witmer coefficients between 2007 and 2018 at our tertiary eye clinic. We report data on corneal endothelial cell (CEC) count, peripapillary retinal nerve fiber layer (RNFL), choroidal thickness (CT) using optical coherence tomography (OCT) as well as clinical findings and management. The unaffected eye served as control. RESULTS Fifty-two eyes of 52 patients were included and followed for 32.8 ± 28.3 months. The peak intraocular pressure was 45 ± 11 mm Hg. The CEC (2241.7 ± 381.1 cells/mm2 vs 2529.4 ± 351.9 cells/mm2, P = .0004) and the global RNFL thickness (80.81 ± 21.01 µm vs 97.38 ± 9.75 µm, P = .0001) were significantly reduced, whereas CT was nonsignificantly higher (295.69 ± 45.46 µm vs 274.00 ± 67.85 µm, P = .156) in the affected eyes compared to the fellow eye. Forty (76.9%) patients were treated with oral valganciclovir (VGC), 2 (3.8%) with topical ganciclovir alone, and 10 (19.2%) received no antiviral therapy. Eight eyes (15.4%) underwent trabeculectomy with mitomycin C. After cessation of oral VGC, 23 patients (57.5%) had recurrences. CONCLUSIONS In our cohort, CMV-positive PSS was often associated with RNFL thinning and CEC loss. Highly elevated intraocular pressures usually present the most relevant challenge. In conjunction with aqueous humor sampling, monitoring by OCT scans and endothelial microscopy may help to guide therapy decisions.
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Affiliation(s)
- Matthias Lenglinger
- From the Department of Ophthalmology, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Therese Schick
- From the Department of Ophthalmology, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dominika Pohlmann
- From the Department of Ophthalmology, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- From the Department of Ophthalmology, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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25
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Nora RLD, Putera I, Mayasari YD, Hikmahwati W, Pertiwi AM, Ridwan AS, Sitompul R, Westcott M, Chee SP, Pavesio C, Thng ZX, Gupta V, Agrawal R. Clinical characteristics and treatment outcomes of Cytomegalovirus anterior uveitis and endotheliitis: a systematic review and meta-analysis. Surv Ophthalmol 2021; 67:1014-1030. [PMID: 34954093 DOI: 10.1016/j.survophthal.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
Cytomegalovirus (CMV) anterior uveitis is the most common form of ocular manifestation of CMV in immunocompetent individuals. The difficulty in diagnosing CMV anterior uveitis may delay adequate treatment and affect outcomes. We sought to review systemically the overall clinical characteristics and compare treatment outcomes in CMV anterior uveitis and endotheliitis. A literature search was performed, and studies describing clinical characteristics, treatment regimens, and outcomes that included more than five treated eyes were included. In these 23 studies, acute CMV anterior uveitis commonly presented with high intraocular pressure (IOP; 95.31%, 95% CI 90.45 - 98.60) and mild anterior chamber inflammation (cells >2+ = 3.18%, 95% CI 0.21- 8.54). About two-thirds of CMV endotheliitis cases presented with high IOP and coin-shaped corneal lesions. Acute CMV anterior uveitis showed good clinical response to topical 0.15% ganciclovir (GCV) gel or oral valganciclovir (VGCV) (90%, 95% CI: 74-100% and 95%, 95% CI: 88-100%, respectively). For chronic CMV anterior uveitis, both topical GCV and oral VGCV yielded comparable results. Topical 0.5-2% GCV or a combination of topical and oral VGCV for CMV endotheliitis both resulted in good clinical response. Recurrence of inflammation was common after cessation of maintenance therapy. Overall, topical GCV resulted in an optimal outcome for CMV anterior uveitis. Escalated concentration and frequency of usage are needed for chronic CMV anterior uveitis and endotheliitis. Adequate induction and maintenance phases of anti-CMV treatment seem necessary to prevent recurrences.
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Affiliation(s)
- Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Yuri Dwi Mayasari
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Wandya Hikmahwati
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Adinda Mulya Pertiwi
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Asri Salima Ridwan
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Ratna Sitompul
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK; University College London Institute of Ophthalmology, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Post Graduate Institute of Medical Education and Research, Chandigarh, India; Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK; University College London Institute of Ophthalmology, London, UK
| | - Zheng Xian Thng
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK; Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Singapore Eye Research Institute, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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26
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Dos Reis C, Miranda BA, da Cunha Afonso AF, Malta E Cunha LH, Trindade BC, Vasconcelos-Santos DV. Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e84. [PMID: 34878042 PMCID: PMC8660025 DOI: 10.1590/s1678-9946202163084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses
that are well-known agents of keratitis, anterior uveitis, scleritis and
retinitis. CMV is usually associated with ocular diseases in immunosuppressed
individuals, with a notable exception of hypertensive anterior uveitis with
distinctive clinical features in immunocompetent patients. This syndrome was
characterized in the last two decades in Europe and Southeast Asia, and then
documented in the rest of world. Definitive diagnosis in these cases is usually
made by Polymerase Chain Reaction (PCR) of the anterior chamber fluid. We report
three immunocompetent Brazilian adults with history of multiple
glaucomatocyclitic crises and presenting with chronic hypertensive anterior
uveitis invariably with mild anterior chamber inflammation and characteristic
scarce nummular keratic precipitates. CMV DNA was successfully amplified and
detected in the aqueous humor of all patients. Corneal endothelial counts were
significantly reduced in the involved eyes, with one patient developing bullous
keratopathy. All patients were then treated with topical ganciclovir gel and
corticosteroids, with subsequent control of the intraocular inflammation. CMV
may represent an overlooked / underestimated etiology of hypertensive anterior
uveitis that may progressively lead to endothelial dysfunction, culminating in
bullous keratopathy. Management of patients is challenging, with the potential
use of topical antivirals to decrease the number of relapses, and
corticosteroids to control anterior uveitis / endotheliitis and to protect the
corneal endothelium.
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Affiliation(s)
- Caroline Dos Reis
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Hospital São Geraldo, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno Avelar Miranda
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Hospital São Geraldo, Belo Horizonte, Minas Gerais, Brazil
| | | | - Leandro H Malta E Cunha
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Hospital São Geraldo, Belo Horizonte, Minas Gerais, Brazil
| | | | - Daniel Vitor Vasconcelos-Santos
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Hospital São Geraldo, Belo Horizonte, Minas Gerais, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Oftalmologia e Otorrinolaringologia, Belo Horizonte, Minas Gerais, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde - Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Cirurgia e à Oftalmologia, Belo Horizonte, Minas Gerais, Brazil.,Instituto da Visão, Belo Horizonte, Minas Gerais, Brazil
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27
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Murai Y, Mori S, Takano F, Ueda K, Sakamoto M, Kurimoto T, Kusuhara S, Yamada-Nakanishi Y, Nakamura M. The beneficial impact of filtration surgery on antiviral therapy cessation in patients with cytomegalovirus-related secondary glaucoma. BMC Ophthalmol 2021; 21:389. [PMID: 34743692 PMCID: PMC8574005 DOI: 10.1186/s12886-021-02155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Cytomegalovirus (CMV)-related keratouveitis elevates intraocular pressure (IOP). Antiviral therapy does not always control IOP and some patients do not tolerate systemic antiviral therapy because of the side effects. The purpose of this study is to evaluate the clinical characteristics of patients with CMV-related keratouveitis and determine the impact of glaucoma surgeries on the postoperative antiviral therapy regimen. Methods We enrolled twenty-two patients with CMV-DNA-positive keratouveitis between June 2012 and July 2019 in Kobe University Hospital. The following clinical parameters were collected: gender, age, history of previous intraocular surgery, antiviral medications, visual acuity, IOP, glaucoma drug score, corneal endothelial cells density, and the mean deviation of a Humphrey visual field test at the first visit and before and 1 year after glaucoma surgery. Results All twenty-two patients started on oral and/or topical antiviral therapy. Eighteen patients needed glaucoma surgery despite their antiviral medications. Nine patients underwent trabeculotomy (TLO) and nine underwent trabeculectomy (TLE) as the first surgical intervention. Six of patients who initially underwent TLO and two of the patients who initially underwent TLE required additional TLE within 1 year. Each of the 15 patients who underwent at least 1 TLE showed a reduction in the magnitude and variation of IOP and glaucoma drug scores and 13 patients were able to discontinue antiviral therapy. For the remaining 4 patients, IOP and inflammation were controlled but with antiviral medications. Conclusions In patients with CMV-related keratouveitis, TLE decreases and stabilizes IOP and contributes to withdrawal from antiviral medications.
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Affiliation(s)
- Yusuke Murai
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sotaro Mori
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Fumio Takano
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kaori Ueda
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mari Sakamoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takuji Kurimoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuko Yamada-Nakanishi
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Zhang S, Zang Y, Lu Q, Ma J, Jiang X, Qu J, Zhang J, Peng R, Luo M, Hong J. Establishing an Animal Model of Cytomegalovirus Keratouveitis in Rats: Broad Infection of Anterior Segment Tissue by Cytomegalovirus. Invest Ophthalmol Vis Sci 2021; 62:22. [PMID: 34698772 PMCID: PMC8556561 DOI: 10.1167/iovs.62.13.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Considering the difficulty of obtaining adequate biological tissue in clinical practice, we established an animal model of cytomegalovirus (CMV) keratouveitis in rats and investigated the viral infection sites and corresponding imaging and histopathological features. Methods Subconjunctival injection and topical use of dexamethasone were used to induce ocular immunosuppression in rats followed by intracameral inoculation of murine cytomegalovirus (MCMV). The clinical manifestations, intraocular pressure (IOP) and imaging changes were observed. Infected eyes were further examined by immunofluorescence, light microscopy, and electron microscopy. MCMV RNA was detected by reverse transcription-polymerase chain reaction. Results Typical keratouveitis occurred in the experimental rats and was characterized by corneal edema, keratic precipitates, and iridocyclitis with increased IOP. Corneal endothelial lesions displayed as “black holes,” enlarged intercellular gaps, and high-intensity cellular infiltration by confocal microscopy, consistent with the pathological changes of “ballooning degeneration,” endothelial cell detachment, and inflammatory cell infiltration. Mitochondrial edema was the most prominent organelle lesion in endothelial cells. Trabeculitis, mechanical obstruction of Schlemm's canal, and anterior chamber angle stenosis accounted for elevated IOP. Inflammation of the iris and ciliary body tended to transform into a chronic form. Immunofluorescence revealed that corneal endothelial cells, iris cells, trabecular meshwork cells, and monocytes could be infected by MCMV. MCMV RNA was found in the anterior segments after infection. Conclusions CMV can widely infect anterior segment tissue, including the corneal endothelium, iris, and trabecular meshwork, in vivo, inducing the corresponding clinical manifestations. Corneal endotheliitis and hypertensive anterior uveitis could be the specific stage of anterior segment infection of CMV.
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Affiliation(s)
- Shuang Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Yunxiao Zang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Qing Lu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jiao Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Xuan Jiang
- State Key Laboratory of Virology, CAS Center for Excellence in Brain Science and Intelligence Technology, Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Jinghao Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jiaxin Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
| | - Minhua Luo
- State Key Laboratory of Virology, CAS Center for Excellence in Brain Science and Intelligence Technology, Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Haidian District, Beijing, China
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Classification Criteria for Cytomegalovirus Anterior Uveitis. Am J Ophthalmol 2021; 228:89-95. [PMID: 33845019 PMCID: PMC8501153 DOI: 10.1016/j.ajo.2021.03.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine classification criteria for cytomegalovirus (CMV) anterior uveitis. DESIGN Machine learning of cases with CMV anterior uveitis and 8 other anterior uveitides. METHODS Cases of anterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the anterior uveitides. The resulting criteria were evaluated on the validation set. RESULTS One thousand eighty-three cases of anterior uveitides, including 89 cases of CMV anterior uveitis, were evaluated by machine learning. The overall accuracy for anterior uveitides was 97.5% in the training set and 96.7% in the validation set (95% confidence interval 92.4, 98.6). Key criteria for CMV anterior uveitis included unilateral anterior uveitis with a positive aqueous humor polymerase chain reaction assay for CMV. No clinical features reliably diagnosed CMV anterior uveitis. The misclassification rates for CMV anterior uveitis were 1.3% in the training set and 0% in the validation set. CONCLUSIONS The criteria for CMV anterior uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
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Kwok JM, Bakshi NK, Lam VW, Fattouh R, Kaplan AJ, Derzko-Dzulynsky LA. Cytomegalovirus anterior uveitis in consecutive eyes with hypertensive uveitis: a tertiary care centre experience. Can J Ophthalmol 2021; 56:e174-e176. [PMID: 34048727 DOI: 10.1016/j.jcjo.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
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Babu K, Konana VK, Ganesh SK, Patnaik G, Chan NSW, Chee SP, Sobolewska B, Zierhut M. Viral anterior uveitis. Indian J Ophthalmol 2021; 68:1764-1773. [PMID: 32823392 PMCID: PMC7690545 DOI: 10.4103/ijo.ijo_928_20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner-Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann-Witmer coefficient analysis on the aqueous humor may help in identifying etiology to plan and monitor treatment.
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Affiliation(s)
- Kalpana Babu
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Vinaya Kumar Konana
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Sudha K Ganesh
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Gazal Patnaik
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nicole S W Chan
- Department of Ophthalmology, National University Hospital, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre; Singapore Eye Research Institute; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Duke-NUS Graduate Medical School Singapore, Singapore
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Papasavvas I, Herbort CP. Cytomegalovirus Anterior Uveitis from the Perspective of the Common Practitioner: Missed Diagnosis Can Be at the Origin of Severe Functional Loss - A Scenario to Be Avoided. Klin Monbl Augenheilkd 2021; 238:448-453. [PMID: 33930916 DOI: 10.1055/a-1425-4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Carl Peter Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
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Anteriore virale Uveitis. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The role of antibody indexes in clinical virology. Clin Microbiol Infect 2021; 27:1207-1211. [PMID: 33813108 DOI: 10.1016/j.cmi.2021.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serological techniques are an essential part of the diagnostic tools used in clinical virology. Among these techniques, antibody indexes are not novel, but do require specific expertise. Their niche has expanded substantially in recent years due to increasing evidence of their performance to diagnose viral infections. OBJECTIVES This narrative review describes the background and clinical applications of antibody indexes. The first objective is to provide an overview of the theoretical background, insights for implementation, limitations and pitfalls. The second objective is to review the available evidence for the diagnostic performance, with a specific focus on viral encephalitis and uveitis. SOURCES A comprehensive literature search was performed in PubMed, including original studies and reviews, with no time limit on the studies included. The following search terms were used: antibody index, Goldmann-Witmer coefficient, Reibergram, viral encephalitis, viral uveitis, herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, rubella virus, measles virus, enterovirus, influenza virus, flaviviruses. CONTENT Antibody indexes can support the diagnosis of a spectrum of viral infections in immune privileged sites such as the central nervous system and the eye, through the demonstration of virus-specific intrathecal or intraocular antibody production. This is especially useful in situations where PCR has a lower positivity rate: infections with rapid viral clearance due to natural immunity or treatment and chronic stages of viral infections. IMPLICATIONS Antibody indexes expand the clinical microbiologist's diagnostic toolbox. Careful interpretation of the results of these assays is crucial and further standardization of methods is required to improve interchangeability of results between laboratories.
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Tanyıldız B, Kaymak NZ, Oklar M, Göktaş E. Peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer changes on optical coherence tomography in patients with unilateral hypertensive cytomegalovirus anterior uveitis. Photodiagnosis Photodyn Ther 2021; 33:102132. [PMID: 33460814 DOI: 10.1016/j.pdpdt.2020.102132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate whether peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning are present in patients with unilateral hypertensive Cytomegalovirus anterior uveitis (hCMV AU). METHODS We included 19 eyes with unilateral hCMV AU and their unaffected fellow eyes as the control group in this study. Peripapillary RNFL and macular GCIPL changes were determined using spectral-domain (SD) - optical coherence tomography (OCT). RESULTS The overall calculated mean pRNFL thickness was significantly lower in the effected eyes with hCMV AU than in the uneffected fellow eyes (p = 0.012). The mean macular GCIPL thickness in the affected eyes was also significantly lower than in the normal eyes (p < 0.001). CONCLUSION Measurement of pRNFL and macular GCIPL thickness with OCT may detect signs of damage before the visual field changes in patients with hypertensive CMV AU. Early aggressive treatment in these patients may prevent further glaucomatous damage.
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Affiliation(s)
- Burak Tanyıldız
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Nilüfer Zorlutuna Kaymak
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Murat Oklar
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Eren Göktaş
- Boyabat 75th Year State Hospital, Department of Ophthalmology, Sinop, Turkey.
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Wong MOM, Yu AHY, Chan CKM. Efficacy and safety of oral valganciclovir in cytomegalovirus anterior uveitis with uncontrolled intraocular pressure. Br J Ophthalmol 2020; 105:1666-1671. [PMID: 33011687 DOI: 10.1136/bjophthalmol-2020-317044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/19/2020] [Accepted: 09/13/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS While cytomegalovirus (CMV) anterior uveitis (AU) patients often require glaucoma surgery, the effectiveness of systemic anti-viral in long-term intraocular pressure (IOP) control is not well established. Our study aims to identify the 2-year efficacy and safety of oral valganciclovir in CMV AU with uncontrolled IOP. METHODS In this retrospective case series, one eye from each of 17 immunocompetent PCR-proven patients with CMV AU who received a single course of oral valganciclovir for 20-148 days for medically uncontrolled IOP during 2008-2018 were identified. They were examined at baseline, week 2, months 1, 2 and 3, then every 3 months up to 2 years after commencement of valganciclovir, or until IOP-lowering procedure. RESULTS Median baseline IOP and IOP-lowering medication were 27.0 mm Hg (IQR: 22.9-31.0 mm Hg), and 4.0, respectively. IOP was significantly lower than baseline from 2 weeks to 12 months and at 21 and 24 months after starting valganciclovir (p=0.001 to 0.041, Wilcoxon sign-rank test), with 16.9-46.0% median IOP reduction. Seven (41.2%) and six (35.3%) patients had IOP≤21 mm Hg with same, or reduced, topical medications by 12 and 24 months, respectively. Median time to IOP-lowering intervention or second course of valganciclovir was 12.4 months. There was no serious medication-related adverse event. Common side effects included reduced monocyte count (9 patients) and deranged renal function/electrolytes (5 patients). IOP spike and wound leak occurred in 35.5% and 29.4% of patients, respectively, after diagnostic aqueous tap. CONCLUSION In CMV AU with uncontrolled IOP, >1/3 of the patients avoided glaucoma surgery over 2 years with a course of oral valganciclovir.
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Affiliation(s)
- Mandy O M Wong
- Hong Kong Eye Hospital, Hong Kong SAR, China .,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Amy H Y Yu
- Hong Kong Eye Hospital, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen K M Chan
- Hong Kong Eye Hospital, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
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Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir. Cornea 2020; 39:584-589. [PMID: 32068609 DOI: 10.1097/ico.0000000000002251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America. METHODS This is a retrospective case series review (2002-2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed. RESULTS Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: -0.21 LogMAR, 95% CI -0.33 to -0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02-0.41; P = 0.002), and IOP (difference: -4.21 mm Hg, 95% CI -7.98 to -0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping. CONCLUSIONS Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.
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Pleyer U, Pohlmann D, Rademacher J. [Anterior Uveitis: Clinic, Diagnostic Procedure and Treatment Options]. Klin Monbl Augenheilkd 2020; 237:1005-1019. [PMID: 32303071 DOI: 10.1055/a-1148-2875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Anterior uveitis involves inflammation of the iris and/or ciliary body and is the most common intraocular inflammation in ophthalmological practice. It can be attributed to an infectious or immune-mediated genesis or be associated with systemic diseases. Anamnesis and (guiding) findings during the slit lamp examination often already provide important information on pathogenesis and thus on further diagnostic clarification and therapy. This includes the assessment of laterality, acute or chronic course of the disease and morphological criteria (granulomatous/non-granulomatous). The guideline-compliant procedure recommends further diagnosis with targeted laboratory diagnostics and, if necessary, consultative examinations if the disease recurs. This is important in order to pursue a targeted treatment approach and to recognize comorbidities.
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Pohlmann D, Pahlitzsch M, Schlickeiser S, Metzner S, Lenglinger M, Bertelmann E, Maier AKB, Winterhalter S, Pleyer U. Virus-associated anterior uveitis and secondary glaucoma: Diagnostics, clinical characteristics, and surgical options. PLoS One 2020; 15:e0229260. [PMID: 32092116 PMCID: PMC7039515 DOI: 10.1371/journal.pone.0229260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/02/2020] [Indexed: 12/18/2022] Open
Abstract
In this retrospective, single-center, observational study, we compared the clinical characteristics, analyzed the glaucoma development, and the glaucoma surgery requirement mediators in patients with different virus-associated anterior uveitis (VAU). In total, 270 patients (= eyes) with VAU confirmed by positive Goldmann-Witmer coefficients (GWC) for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubella virus (RV), and multiple virus (MV) were included. Clinical records of these patients were analyzed. Demographic constitution, clinical findings, glaucoma development, and surgeries were recorded. The concentrations of 27 immune mediators were measured in 150 samples of aqueous humor. The GWC analysis demonstrated positive results for CMV in 57 (21%), HSV in 77 (29%), VZV in 45 (17%), RV in 77 (29%), and MV in 14 (5%) patients. CMV and RV AU occurred predominantly in younger and male patients, while VZV and HSV AU appeared mainly with the elderly and females (P<0.0001). The clinical features of all viruses revealed many similarities. In total, 52 patients (19%) showed glaucomatous damage and of these, 27 patients (10%) needed a glaucoma surgery. Minimal-invasive glaucoma surgery (MIGS) showed a reliable IOP reduction in the short-term period. In 10 patients (37%), the first surgical intervention failed and a follow-up surgery was required. We conclude that different virus entities in anterior uveitis present specific risks for the development of glaucoma as well as necessary surgery. MIGS can be suggested as first-line-treatment in individual cases, however, the device needs to be carefully chosen by experienced specialists based on the individual needs of the patient. Filtrating glaucoma surgery can be recommended in VAU as an effective therapy to reduce the IOP over a longer period of time.
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Affiliation(s)
- Dominika Pohlmann
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Milena Pahlitzsch
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité–University Medicine, Berlin, Berlin, Germany
| | - Sylvia Metzner
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Lenglinger
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eckart Bertelmann
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna-Karina B. Maier
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sibylle Winterhalter
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Kim JH, Lee JY, Choi JA. Comparison of Clinical Characteristics between Patients with Cytomegalovirus Positive and Negative Hypertensive Uveitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.3.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin-Ho Kim
- Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea
| | - Ji-Young Lee
- Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea
| | - Jin-A Choi
- Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea
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Murata K, Ishida K, Ozawa K, Sawada A, Mochizuki K, Yamamoto T. The characteristics of Posner-Schlossman syndrome: A comparison in the surgical outcome between cytomegalovirus-positive and cytomegalovirus-negative patients. Medicine (Baltimore) 2019; 98:e18123. [PMID: 31770242 PMCID: PMC6890343 DOI: 10.1097/md.0000000000018123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This retrospective observational study aims to report the clinical characteristics and surgical results in eyes with Posner-Schlossman syndrome (PSS), and compare these outcomes between cytomegalovirus (CMV)-positive and -negative eyes.We reviewed the medical records of 21 consecutive immunocompetent patients clinically diagnosed with PSS between the years 2010 and 2018. Aqueous humor was collected from all the affected eyes to detect if CMV was present, and polymerase chain reaction (PCR) was performed using the herpesvirus family primers.The average period between the initial PSS attack and aqueous humor sampling at our institute was 9.3 years. Out of the 21 patients, 62% were CMV-positive. Regardless of CMV status, the mean intraocular pressure (IOP), mean deviation (MD), and central corneal endothelium cell (CEC) density, at the initial examination at our institute were already significantly worse in the affected eyes than in the unaffected eyes (all P values < .05). The average visual acuity (VA) was only significantly worse in the CMV-positive group (P = .02). Out of all the patients, those that were CMV-positive had undergone more glaucoma surgeries (P = .056). Fourteen patients underwent either a trabeculectomy (TRAB) or a trabeculotomy (LOT), and their IOP significantly reduced following surgery (P < .001). In 85.7% of those that had surgery, their IOP was successfully lowered to less than 20 mm Hg.Long-lasting PSS causes a decrease in VA, MD, and the CEC density. A prompt diagnosis is required, and an appropriate treatment plan should be formulated. In those patients with PSS that develop uncontrolled glaucoma, both TRAB and LOT may be effective in controlling IOP.
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Affiliation(s)
- Kazuhiro Murata
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center, Japan
| | - Kenji Ozawa
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Akira Sawada
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine
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Leleu I, Jhanji V, Touhami S, Westcott M, Angi M, Titah C, Rousseau A, Hamard P, Brasnu E, Manicom T, Blumen-Ohana E, Rozenberg F, Vauloup-Fellous C, Deback C, Labetoulle M, Sahel JA, Bodaghi B, Merabet L, Kobal A, Brignole-Baudouin F, Errera MH. Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients. Ocul Immunol Inflamm 2019; 29:160-168. [PMID: 31642720 DOI: 10.1080/09273948.2019.1662059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin.Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc.Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir.Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients.
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Affiliation(s)
- Igor Leleu
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | | | - Sara Touhami
- Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France.,Department of Ophthalmology, Hôpital de Lariboisière, Paris, France
| | - Mark Westcott
- Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK.,Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
| | - Martina Angi
- Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Cherif Titah
- Department of Ophthalmology, Fondation Ophthalmologique de Rothschild, Paris, France
| | - Antoine Rousseau
- Department of Ophthalmology, Hôpital Bicêtre, Université Paris Sud, APHP, Paris, France
| | - Pascale Hamard
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Emmanuelle Brasnu
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Thomas Manicom
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Esther Blumen-Ohana
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Flore Rozenberg
- Université Paris Descartes, Paris, France.,Virology Department, Hôpital Cochin, Université Paris V, Paris, France
| | | | - Claire Deback
- Virology Department, Université Paris Sud, APHP, Villejuif, France
| | - Marc Labetoulle
- Department of Ophthalmology, Hôpital Bicêtre, Université Paris Sud, APHP, Paris, France
| | - Jose-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France.,Sorbonne Universités, UPMC Univ Paris VI, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Universités, UPMC Univ Paris VI, Paris, France
| | - Lilia Merabet
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Alfred Kobal
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Françoise Brignole-Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France.,Virology Department, Hôpital Cochin, Université Paris V, Paris, France
| | - Marie-Hélène Errera
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France.,Pittsburgh University Hospital, Pittsburgh, PA, USA.,Sorbonne Universités, UPMC Univ Paris VI, Paris, France
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Fuchs endothelial corneal dystrophy and corneal endothelial diseases: East meets West. Eye (Lond) 2019; 34:427-441. [PMID: 31267087 DOI: 10.1038/s41433-019-0497-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/21/2019] [Accepted: 04/27/2019] [Indexed: 12/13/2022] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is amongst one of the most common indications for endothelial keratoplasty worldwide. Despite being originally described among Caucasians, it is now known to be prevalent among a large number of populations, including Asians. While the FECD phenotype is classically described as that of central guttate and pigment deposits associated with corneal endothelial dysfunction, there are subtle yet important differences in how FECD and its phenocopies may present in Caucasians vs Asians. Such differences are paralled by genotypic variations and disease management preferences which appear to be geographically and ethnically delineated. This article provides a succinct review of such differences, with a focus on diagnostic and management issues which may be encountered by ophthalmologists practicing in the different geographic regions, when evaluating a patient with FECD.
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45
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Aqueous tap and rapid diagnosis of cytomegalovirus anterior uveitis: the Reggio Emilia experience. Graefes Arch Clin Exp Ophthalmol 2018; 257:181-186. [DOI: 10.1007/s00417-018-4180-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/19/2022] Open
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