Clinical Characteristics and Aqueous Humor Laboratory Analysis of Chinese Patients With Rubella Virus-Associated and Cytomegalovirus-Associated Fuchs Uveitis Syndrome.

Hao Kang,Yong Tao,Yanhong Shi,Hui Wang,Xiaofeng Hu,Han Bao,Yinzhang He,Jing Feng,Weiqiang Yang

doi:10.3389/fmed.2020.610341

Abstract

Purpose: To describe and compare the clinical characteristics and laboratory analysis results of aqueous humor (AH) in fuchs uveitis syndrome (FUS) patients caused by rubella virus (RV) and cytomegalovirus (CMV).Methods: A retrospective and observation-based study was performed on 32 patients with FUS. Etiologies, clinical characteristics, ocular complications, visual prognoses, inflammatory cytokines, and virus-specific antibodies in AH were compared.Results: Among all the cases involved, 24 had RV FUS and 8 had CMV FUS. The mean age at diagnosis of FUS in the CMV group was older than that of the RV group (P = 0.031). The mean LogMAR best corrected visual acuity (BCVA) at initial presentation and at the final visit were both significantly higher in the CMV FUS group than those in the RV FUS group (P = 0.004, 0.047). The highest intraocular pressure (IOP) was significantly higher in the CMV group (P = 0.040). Consistent with elevated IOP, the CMV FUS patients were significantly more prone to developing glaucoma eventually than the RV FUS patients (P = 0.039). Vitreous opacity was found in 66.7% of the RV patients and 25.0% of the CMV patients (P = 0.038). The gender ratio, initial symptoms, presence and types of keratic precipitates, severity of anterior segment inflammation, iris lesions, and incidence of complicated cataract were similar between the two groups. There was no detectable difference of inflammatory cytokines in AH between RV FUS and CMV FUS.Conclusion: The clinical manifestations and disease prognosis vary between CMV FUS and RV FUS. However, clinical differences are always not obvious enough for differential diagnosis. The laboratory AH analysis is necessary to identify the etiology, determine the therapeutic strategies, and assess the disease prognosis.

Highlights

Fuchs uveitis syndrome (FUS), as a chronic, typically unilateral, usually asymptomatic mild inflammatory disorder, predominantly involves the anterior uvea and vitreous [1]
According to the theory of infection, the infection of rubella virus (RV), cytomegalovirus (CMV), herpes simplex virus (HSV), ocular toxoplasmosis, and other viruses have been implicated in the pathogenesis of FUS [2]
CMV infection accounts for 16–42% in Asian FUS cases of FUS, while Western FUS cases are predominantly associated with rubella virus rather than with CMV [5, 10, 11]

Summary

Introduction

Fuchs uveitis syndrome (FUS), as a chronic, typically unilateral, usually asymptomatic mild inflammatory disorder, predominantly involves the anterior uvea and vitreous [1]. Diagnosis of FUS is mainly based on clinical manifestations because the etiology remains obscure. RV and CMV are the most commonly reported infectious etiologic agents of FUS [3,4,5,6]. Several clinical studies have demonstrated that RV plays a pivotal role in the pathogenesis of FUS in Western patients [7,8,9]. FUS caused by CMV infection occurs more frequently in Asian countries. CMV infection accounts for 16–42% in Asian FUS cases of FUS, while Western FUS cases are predominantly associated with rubella virus rather than with CMV [5, 10, 11]. As to different virus species of pathogenic microorganisms, there are some differences in clinical features among the patients from different etiological infections

Methods

Results

Conclusion