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Tranos P, Markomichelakis N, Koronis S, Sidiropoulos G, Tranou M, Rasoglou A, Stavrakas P. CMV-Related Anterior Uveitis in a Mediterranean European Population: Clinical Features, Prognosis, and Long-Term Treatment Outcomes. Ocul Immunol Inflamm 2024:1-6. [PMID: 38621024 DOI: 10.1080/09273948.2024.2329315] [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: 08/23/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To describe the spectrum of clinical features of cytomegalovirus-related anterior uveitis (CMV-AU) along with potential comorbidities, to calculate complication rates, and to determine risk factors and biomarkers affecting prognosis in a cohort of a Southern European Mediterranean population. MATERIALS AND METHODS It is a retrospective, multicenter case series of consecutive patients with persisting hypertensive AU, unresponsive to topical steroids therapy, and CMV-positive essays from two uveitis referral centers were collected and analyzed. RESULTS Fifty-seven eyes of 53 patients with polymerase chain reaction-verified CMV-AU over a period of 8 years were included with a mean age of 48 ± 18. Four presentation patterns were identified: 26.3% as Posner-Schlossman-like, 31.6% as chronic AU, 19.3% as presumed herpetic uveitis, 12.3% as Fuchs uveitis syndrome-like, and 10.5% without specific initial classification. About 15.8% received oral valganciclovir, 22.8% received topical valganciclovir, and 61.4% received both, for a mean duration of treatment of 44 months. AU recurrences were observed in 23 eyes with a mean of 1.5 (±1.5) recurrences per year. The only finding significantly associated with recurrence was the presence of posterior synechiae (PS) (p = 0.034). Fewer keratic precipitates (KPs) were indicative for the need of longer treatment, and endotheliitis was strongly associated with the need for filtration surgery. CONCLUSION In this immunocompetent southern European population, four distinct clinical presentation patterns were further confirmed, and possible biomarkers such as PS, KPs, and endotheliitis were newly reported to influence treatment outcomes. Large-scale studies could provide a more effective customized treatment protocol.
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Affiliation(s)
- Paris Tranos
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | | | - Spyridon Koronis
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | | | - Marianna Tranou
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | - Achilleas Rasoglou
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | - Panagiotis Stavrakas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
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Hönemann M, Scharfenberg E, Dietze N, Claus C, Jochmann C, Liebert UG. Rubella virus-associated uveitis at a tertiary care hospital in Germany between 2013 and 2019. BMC Ophthalmol 2023; 23:447. [PMID: 37932668 PMCID: PMC10629089 DOI: 10.1186/s12886-023-03182-y] [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: 07/23/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
Uveitis is a process of intraocular inflammation that may involve different sections of the uveal tract. Apart from systemic or localized immune-mediated diseases, infections are key players in the etiology of uveitis and entail different treatment strategies. Rubella virus (RuV) is a recognized causative agent for the development of Fuchs uveitis, representing a major cause of virus-associated intraocular inflammation. A cohort of 159 patients diagnosed with different forms of uveitis between 2013 and 2019 was subjected to diagnostic antibody testing of the aqueous or vitreous humor. The diagnostic panel included RuV, cytomegalovirus, herpes simplex virus, varicella-zoster virus, and toxoplasmosis. Within this cohort, 38 RuV-associated uveitis (RAU) patients were identified based on a pathologic Goldman-Witmer coefficient indicative of an underlying RuV infection. With a mean age of 45.9 years, the RAU patients were younger than the non-RAU patients (56.3, p < 0.001). The evaluation of clinical parameters revealed a predominance of anterior uveitis and late sequalae such as cataract and glaucoma among the RAU patients. In 15 of the patients a history of prior RuV infections could be confirmed. The study underlines the importance of long-term surveillance of RuV associated diseases that originate from infections before the introduction of RuV vaccination programs.
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Affiliation(s)
- Mario Hönemann
- Institute of Medical Microbiology and Virology, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany.
| | - Elizabeth Scharfenberg
- Department of Ophthalmology, University Hospital Leipzig, Leipzig University, Liebigstrasse 21, 04103, Leipzig, Germany
| | - Nadine Dietze
- Institute of Medical Microbiology and Virology, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany
| | - Claudia Claus
- Institute of Medical Microbiology and Virology, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany
| | - Claudia Jochmann
- Department of Ophthalmology, University Hospital Leipzig, Leipzig University, Liebigstrasse 21, 04103, Leipzig, Germany
| | - Uwe Gerd Liebert
- Institute of Medical Microbiology and Virology, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany
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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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Cheng YY, Wang CY, Zheng YF, Ren MY. Hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome: A case report. World J Clin Cases 2022; 10:13081-13087. [PMID: 36568999 PMCID: PMC9782945 DOI: 10.12998/wjcc.v10.i35.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hammered silver appearance of the corneal endothelium is considered a characteristic change in iridocorneal-endothelial syndrome. Herein we report an interesting case of hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome (FUS).
CASE SUMMARY A 49-year-old man with progressive vision loss in the right eye for one year was admitted to our hospital. The clinical manifestations of the patient’s right eye were mild conjunctival hyperemia, scattered stellate keratic precipitates on the corneal endothelium, normal depth anterior chamber, 2+ cellular reaction in the aqueous humor, diffuse iris depigmentation, absence of synechia, Koeppe nodules, opalescent lens, and vitreous opacity. FUS and a complicated cataract were diagnosed based on the typical clinical manifestations. The corneal endothelial changes were recorded in detail by slit-lamp examination, specular microscopy, and in vivo confocal microscopy before cataract extraction, revealing a hammered silver appearance of the corneal endothelium in the affected eye, a wide-band dark area, as well as irregular corneal endothelial protuberances and dark bodies of various sizes. Subsequently, the patient underwent phacoemulsification combined with intraocular lens implantation, and his postoperative visual acuity recovered to 1.0.
CONCLUSION Hammered silver appearance of the corneal endothelium in FUS, which is considered a more serious manifestation of endothelial damage, is rare and may be caused by many irregular protrusions in the corneal endothelium.
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Affiliation(s)
- Yan-Yan Cheng
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
| | - Cong-Ying Wang
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
| | - Yan-Fang Zheng
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
| | - Ming-Yu Ren
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
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