Frequency of dendritiform inflammatory cells in the cornea in herpetic anterior uveitis without clinical keratitis and Fuchs uveitis.

Alexandra B Knoll,Friederike Mackensen,Gerd U Auffarth,Andreea S Postole

doi:10.1186/s12348-014-0031-y

Alexandra B Knoll, Friederike Mackensen + Show 2 more

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https://doi.org/10.1186/s12348-014-0031-y

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Abstract

BackgroundHerpetic anterior uveitis is a frequent cause of infectious uveitis. A definite diagnosis is obtained by anterior chamber puncture and polymerase chain reaction, an invasive procedure. We hypothesized that patients with herpetic anterior uveitis have a certain pattern of inflammatory cells in their cornea that distinguishes herpetic anterior uveitis from other uveitis types. This study is a prospective, controlled, observational study. Ten patients are with active herpetic anterior uveitis and 14 patients are with Fuchs uveitis syndrome. Patients were imaged with the Heidelberg Retina Tomograph with the Rostock Cornea Module attachment. Three images of the subepithelial area of the cornea were evaluated for dendritiform inflammatory cells. Means were calculated and used for analysis. The contralateral unaffected eyes and numbers published in the literature served as controls.ResultsThe number of dendritiform inflammatory cells in herpetic anterior uveitis was compared to that in the Fuchs uveitis syndrome. Of the eyes of patients with herpetic anterior uveitis, 80% had an average of 98.0±10.8 cells/mm2 (mean±standard error of the mean (SEM), n=10) in their affected eyes and 60.4±26.4 cells/mm2, (n=6) in 30% of their fellow eyes. Patients with Fuchs uveitis syndrome had moderately elevated dendritiform inflammatory cells (47.0±9.7 cells/mm2, n=14) in 96.4% of their affected eyes and normal numbers (23.0±7.3 cells/mm2, n=13) in 46.4% of their fellow eyes. The difference between the four groups was significant (p=0.0004).ConclusionsPatients with herpetic anterior uveitis had significantly higher levels of dendritiform inflammatory cells in their subepithelial cornea than patients with Fuchs uveitis syndrome, which can be detected by in vivo confocal microscopy. The clinically unaffected eyes of herpetic anterior uveitis patients showed a co-response regarding dendritiform inflammatory cell elevation. We conclude that high numbers of dendritiform inflammatory cells in the cornea of uveitis patients may support the clinical diagnosis of herpetic anterior uveitis.

Highlights

Anterior uveitis (AU) is the most frequent localization of uveitis [1,2]
While we examined corneas of uveitis patients with the Heidelberg Retina Tomograph (HRT)-Rostock cornea module (RCM) in a previous study looking at keratic precipitates [10], it became apparent that patients with herpetic AU, but not with other types of AU, frequently had high amounts of dendritiform inflammatory cells (DC) in their central cornea
Diagnosis of herpetic anterior uveitis (HAU) was based on the clinical presentation [11] (unilateral, granulomatous anterior uveitis with intraocular pressure (IOD) elevation [12] and iris atrophy but no corneal involvement) and confirmed either by anterior chamber puncture and polymerase chain reaction (PCR) (2/10 patients) or by improvement due to acyclovir therapy (10/10)

Summary

Introduction

Anterior uveitis (AU) is the most frequent localization of uveitis [1,2]. Most cases of AU are associated with either a systemic disease (approx. 30%), a clearly defined ocular syndrome (approx. 30%), are unclassified or idiopathic disease (approx. 25%) or with an infection (9.5%). Among the infectious forms, herpes virus infections and Fuchs uveitis syndrome (FUS) are the most common etiologies [1]. The clinical presentations of these two frequent types of AU show similarities, making it sometimes difficult to distinguish them from each other. Both typically present with a unilateral uveitis associated with iris atrophy and intraocular pressure elevation [3] (reviewed in [4]). An anterior chamber puncture and aqueous humour analysis for viral polymerase chain reaction (PCR) or intraocular. Herpetic anterior uveitis is a frequent cause of infectious uveitis. Ten patients are with active herpetic anterior uveitis and 14 patients are with Fuchs uveitis syndrome. The contralateral unaffected eyes and numbers published in the literature served as controls

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