J Korean Ophthalmol Soc.  2010 Sep;51(9):1245-1249. 10.3341/jkos.2010.51.9.1245.

Cytomegalovirus as a Cause of Recurrent Anterior Uveitis in Immunocompetent Patients

• Park J
• Chung JL
• Lee SH
• Hong YJ

• KMID: 2122292
• DOI: http://doi.org/10.3341/jkos.2010.51.9.1245

Abstract

PURPOSE
This study aimed to identify various infectious causes in unilateral recurrent hypertensive anterior uveitis in immunocompetent individuals.
METHODS
Twenty eyes of 20 patients diagnosed with recurrent hypertensive anterior uveitis, who had negative systemic uveitis lab results, were enrolled. Polymerase chain reaction (PCR) was performed in the aqueous humor and peripheral blood specimens to detect the following infectious agents: cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), varicella zoster virus (VZV), toxoplasma.
RESULTS
The mean age of 20 patients was 41.8 +/- 15.9 year (19-77 year), and 14 (70%) patients were male. CMV was positive in 7 eyes (35%) and was detected only in aqueous humor. HSV-1 was positive in 5 (25%) eyes; only in aqueous humor in 2 eyes, only in blood in 1 eye, and in both specimens in 2 eyes. Only 1 (5%) eye was positive for toxoplasma in the aqueous humor.
CONCLUSIONS
This study demonstrated that CMV might be another major infectious cause in recurrent hypertensive anterior uveitis in immunocompetent patients. If CMV is detected, it might be reasonable to add appropriate antiviral agents, rather than treating only with immunosuppresive and hypotensive drugs.

Keyword

Cytomegalovirus; Polymerase chain reaction; Recurrent hypertensive anterior uveitis

MeSH Terms

Antiviral Agents
Aqueous Humor
Cytomegalovirus
Eye
Herpes Simplex
Herpesvirus 1, Human
Herpesvirus 3, Human
Humans
Male
Methylmethacrylates
Polymerase Chain Reaction
Polystyrenes
Pyridines
Thiazoles
Toxoplasma
Uveitis
Uveitis, Anterior
Antiviral Agents
Methylmethacrylates
Polystyrenes
Pyridines
Thiazoles

Reference

1. Mietz H, Aisenbrey S, Ulrich Bartz-Schmidt K, et al. Ganciclovir for the treatment of anterior uveitis. Graefes Arch Clin Exp Ophthalmol. 2000. 238:905–909.

2. Markomichelakis NN, Canakis C, Zafirakis P, et al. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology. 2002. 109:879–882.

3. Teoh SB, Thean L, Koay E. Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye. 2005. 19:1338–1340.

4. De Schryver I, Rozenberg F, Cassoux N, et al. Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis. Br J Ophthalmol. 2006. 90:852–855.

5. Van Boxtel LA, van der Lelij A, van der Meer J, Los LI. Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology. 2007. 114:1358–1362.

6. Chee SP, Bacsal K, Jap A, et al. Clinical Features of Cytomegalovirus Anterior Uveitis in Immunocompetent Patients. Am J Ophthalmol. 2008. 145:834–840.

7. Hwang YS, Lin KK, Lee JS, et al. Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis. Graefes Arch Clin Exp Ophthalmol. 2010. 248:263–269.

8. Griffais R, André PM, Thibon M. K-tuple frequency in the human genome and polymerase chain reaction. Nucleic Acids Res. 1991. 19:3887–3891.

9. Hurtado A, Aduriz G, Moreno B, et al. Single tube nested PCR for the detection of Toxoplasma gondii in fetal tissues from naturally aborted ewes. Vet Parasitol. 2001. 102:17–27.

10. Koizumi N, Suzuki T, Uno T, et al. Cytomegalovirus as an etiologic factor in corneal endotheliitis. Ophthalmology. 2008. 115:292–297.

11. Winston DJ, Busuttil RW. Randomized controlled trial of oral ganciclovir versus oral acyclovir after induction with intravenous ganciclovir for long-term prophylaxis of cytomegalovirus disease in cytomegalovirus-seropositive liver transplant recipients. Transplantation. 2003. 75:229–233.

12. Henderly DE, Freeman WR, Causey DM, Rao NA. Cytomegalovirus retinitis and response to therapy with ganciclovir. Ophthalmology. 1987. 94:425–434.

13. Anduze-Faris BM, Fillet AM, Gozlan J, et al. Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients. AIDS. 2000. 14:517–524.

14. Lee SH, Park G, Yang YG, et al. Rapid ABO genotyping using whole blood without DNA purification. Korean J Lab Med. 2009. 29:231–237.

15. Chou Q, Russell M, Birch DE, et al. Prevention of pre-PCR mis-priming and primer dimerization improves low-copynumber amplifications. Nucleic Acids Res. 1992. 11:1717–1723.

16. Murphy J, Bustin SA. Reliability of real-time reverse-transcription PCR in clinical diagnostics: gold standard or substandard? Expert Rev Mol Diagn. 2009. 9:187–197.

17. Yang YG, Kim JY, Song YH, Kim DS. A novel buffer system,AnyDirect, can improve polymerase chain reaction from whole blood without DNA isolation. Clin Chim Acta. 2007. 380:112–117.