New spectrum of Herpes virus‐associated anterior uveitis in immunocompetent patients: a PCR‐based study

Abstract

Abstract Purpose To study clinical characteristics and long term follow up of patients with positive viral PCR in the aqueous humor. Clinical specificities of patients with HSV, VZV ans CMV infection are reviewed. Methods 34 patients (19 M/15F) were included in this retrospective study.We counted the repartition of each virus among the positive viral PCR in the aqueous humor realised for anterior uveitis. We also noticed clinical features for each virus :sex, age, laterality, iris atrophy, synechiae, hypertonia, type and localisation of keratic precipitates, glaucoma. Results Mean age at diagnosis was 49.5 (range 19‐73) years for CMV, 64 (range 21‐69) years for VZV, 53 (range 32‐72) years for HSV. Sex ratio (M:F) was 10/9 for CMV, 4/2 for VZV and 5/3 for HSV positive patients. Viral anterior uveitis was CMV‐related in 58% of cases, VZV‐related in 15% of cases, and HSV‐related in 27% of patients. Uveitis was unilateral in 100% of HSV and VZV patients and in 84% of CMV patients. Iris atrophy, when present, was diffuse in 100% of CMV positive patients and sectoral in 50% HSV and 20% of VZV patients. No patient with CMV infection had synechiae, but 56% of patients had synechiae in the HSV group. Glaucoma complicated uveitis in 79% of CMV cases, 60% of VZV cases, and 56% of HSV cases. None of the patients with positive PCR had the clinical presentation of Fuchs heterochromic cyclitis. Conclusion CMV‐related anterior uveitis has a large place among viral anterior uveitis. Specific clinical features should lead to high suspicion of this diagnosis, and PCR should be applied to the aqueous humor in order to initiate the appropriate treatment.