Abstract
In this retrospective, single-center, observational study, we compared the clinical characteristics, analyzed the glaucoma development, and the glaucoma surgery requirement mediators in patients with different virus-associated anterior uveitis (VAU). In total, 270 patients (= eyes) with VAU confirmed by positive Goldmann-Witmer coefficients (GWC) for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubella virus (RV), and multiple virus (MV) were included. Clinical records of these patients were analyzed. Demographic constitution, clinical findings, glaucoma development, and surgeries were recorded. The concentrations of 27 immune mediators were measured in 150 samples of aqueous humor. The GWC analysis demonstrated positive results for CMV in 57 (21%), HSV in 77 (29%), VZV in 45 (17%), RV in 77 (29%), and MV in 14 (5%) patients. CMV and RV AU occurred predominantly in younger and male patients, while VZV and HSV AU appeared mainly with the elderly and females (P<0.0001). The clinical features of all viruses revealed many similarities. In total, 52 patients (19%) showed glaucomatous damage and of these, 27 patients (10%) needed a glaucoma surgery. Minimal-invasive glaucoma surgery (MIGS) showed a reliable IOP reduction in the short-term period. In 10 patients (37%), the first surgical intervention failed and a follow-up surgery was required. We conclude that different virus entities in anterior uveitis present specific risks for the development of glaucoma as well as necessary surgery. MIGS can be suggested as first-line-treatment in individual cases, however, the device needs to be carefully chosen by experienced specialists based on the individual needs of the patient. Filtrating glaucoma surgery can be recommended in VAU as an effective therapy to reduce the IOP over a longer period of time.
Highlights
Virus-associated anterior uveitis (VAU) is caused by cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), and rubella virus (RV)
Prior studies reported that reverse transcription (RT)—polymerase chain reaction (PCR) has frequently failed to demonstrate the presence of RV RNA in Fuchs‘Uveitis Syndrome (FUS) due to a low-viral load below detection level and a high-rate of anti-RV antibodies which block the viral replication. [5,6,7,8,9] For the analysis of immunoglobulin fraction in the aqueous humor (AH) and serum, the use of GoldmannWitmer coefficient (GWC) is mandatory to differentiate RV, but it is mandatory for all other herpetic viruses especially in a period of latency
The CMV and RV patients were younger than the HSV, VZV, and especially the multiple virus (MV) cohort (P
Summary
Virus-associated anterior uveitis (VAU) is caused by cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), and rubella virus (RV). CMV is a well-known cause of secondary glaucoma with high IOP levels >30mmHg,[11] first described by Posner and Schlossman in 1948.[12,13,14] Approximately 10–40% of VAU patients could develop glaucoma.[15,16,17,18,19,20] One very important risk factor for the development of chronic glaucoma is the number of IOP peaks.[15] patients developing glaucoma usually present themselves with high IOP levels at their first inflammatory episode.[15] The amount of the viral load is significantly associated with the number of uveitic recurrences.[21] 19% of VAU patients (VZV and HSV) needed surgical intervention to control individually elevated IOP levels.[15]
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