Diagnosis Of Uveitis Research Articles

The effect of body position on intraocular pressure in calves.

Tonometry is one of the basic diagnostic tests used for the diagnosis of glaucoma and uveitis in veterinary ophthalmology. The Icare® Rebound Tonometer which is a new tonometric device has been shown to be useful in a wide range of species. Eyes (n = 48) of 24 Simmental and Montafon calves with a mean age of 7.5 weeks (2–16 weeks), male and female, were subjected to intraocular pressure (IOP) measurement using the Icare® Rebound Tonometer with calves standing and in lateral recumbency. The mean IOP was measured as 9.02 ± 2.38 mmHg in the right eye and 9.08 ± 2.55 mmHg in the left eye. No age-related change was found in intraocular pressure of the calves between 2 and 16 weeks of age. No difference in IOP values was observed between Simmental and Montafon calves. Body position had no effect on IOP in calves. The Icare® Rebound Tonometer was shown to be a suitable diagnostic device for IOP measurement in calves.

Epidemiology of uveitis (2013\u20132015) and changes in the patterns of uveitis (2004\u20132015) in the central Tokyo area: a retrospective study

BackgroundThe distribution of uveitis varies with genetic, ethnic, geographic, environmental, and lifestyle factors. Epidemiological information about the patterns of uveitis is useful when an ophthalmologist considers the diagnosis of uveitis. Therefore, it is important to identify the causes of uveitis over the years in different regions. The purposes of this study were to characterize the uveitis patients who first arrived at the University of Tokyo Hospital in 2013–2015, and to analyze the changes in the patterns of uveitis from 2004 to 2012 to 2013–2015.MethodsWe retrospectively identified 750 newly arrived patients with uveitis who visited the Uveitis Clinic in the University of Tokyo Hospital between January 2013 and December 2015, using clinical records. We extracted data on patient age, sex, diagnosis, anatomic location of inflammation, laboratory test results of blood and urine, and chest X-ray and fluorescein fundus angiography findings for each patient. In addition, we compared these data with those from 2004 to 2012 to analyze the changes in the patterns of uveitis.ResultsA definite diagnosis was established in 445 patients (59.3%). The most common diagnoses were herpetic iridocyclitis (7.5%), sarcoidosis (6.1%), Behçet’s disease (4.4%), Vogt–Koyanagi–Harada disease (4.1%), and intraocular lymphoma (4.1%). The most frequent unclassified type of uveitis was suspected sarcoidosis (22.3%). Analysis of the changes in the patterns of uveitis in the central Tokyo area from 2004 to 2012 to 2013–2015 revealed notable increasing trends of herpetic iridocyclitis and intraocular lymphoma, and increasing trends of bacterial endophthalmitis, fungal endophthalmitis, and juvenile chronic iridocyclitis. In contrast, the frequency of sarcoidosis, Behçet’s disease, and Vogt–Koyanagi–Harada disease decreased.ConclusionsThe patterns of uveitis changed considerably from 2004 to 2012 to 2013–2015. Continuous investigations about the epidemiology of uveitis are needed to diagnose uveitis more accurately.

Incidence, management and outcome of raised intraocular pressure in childhood-onset uveitis at a tertiary referral centre.

To investigate the incidence, management and outcome of uveitis and raised intraocular pressure (IOP)in children treated at the Manchester Uveitis Clinic (MUC). This was a retrospective, observational study of patients who presented with uveitis under the age of 16 to the MUC from July 2002 to June 2016. A total of 320 children were included in the study. Out of these, 55 (17.2%)patients (75 eyes) were found to have raised IOP requiring treatment. The mean age at diagnosis of uveitis and at first recorded raised IOP was 8.2±4.3 and10.8±3.6 years,respectively. The pre-treatment IOP was 32.3±6.6 mmHg and the IOP at the final visit was 15.5±3.7 mmHg (median follow-up period,43.7 months) on a median number of 0 medications. Twenty-eight eyes (37.3%) required glaucoma drainage surgery, and eight eyes (12.5%) had cyclodiode laser before this. Kaplan-Meier analysis showed that 11.5% of eyes required glaucoma surgery at 1 year after diagnosis of raised IOP, increasing to 50.0% by 5 years. The best-corrected visual acuity at diagnosis of uveitis was 0.26±0.42 logMAR, which remained stable at 0.28±0.65 logMAR at final follow-up visit. Four eyes (5.3%) from fourpatients fulfilled the definition of blindness by the WHO criteria. The mean cup:discratio at final follow-up was 0.4. Our cohort of children with raised IOP appeared to have a good outcome overall through aggressive medical and surgical management. Regular long-term follow-up is recommended, and early surgical intervention in eyes with uncontrolled IOP can prevent loss of vision.

TWENTY-FOUR MONTH FOLLOW-UP OF TOCILIZUMAB THERAPY FOR REFRACTORY UVEITIS-RELATED MACULAR EDEMA.

To report the 24-month efficacy and safety of the interleukin-6 receptor antagonist tocilizumab (TCZ) for refractory uveitis-related macular edema (ME). Data were obtained by standardized chart review. Patients with quiescent uveitis seen at a single tertiary referral center, for whom ME was the principal cause of reduced visual acuity. Central foveal thickness measured by optical coherence tomography; degree of anterior and posterior chamber; inflammation (Standardization of Uveitis Nomenclature Working Group criteria); and visual acuity (Snellen and logarithm of the minimum angle of resolution) were recorded in all patients during TCZ therapy at months 1, 3, 6, 12, 18, and 24. Sixteen eyes from 12 patients (10 women) were included. Mean age was 34.6 years. Mean duration of ME was 13.2 years. All patients achieved 24 months of follow-up and that is the census date for data collection. Before TCZ was commenced, ME was present, and all patients had been previously treated with immunosuppressive therapy and biologic agents. Uveitis diagnoses were juvenile idiopathic arthritis associated, uveitis (n = 6), birdshot chorioretinopathy (n = 2), idiopathic panuveitis (n = 2), sympathetic ophthalmia (n = 1), and ankylosing spondylitis (n = 1). Mean central foveal thickness (95%; confidence interval) was 516 ± 55 μm at baseline, improving to 274 ± 13 at Month 12 (P = 0.0004), and sustained at 274 ± 14 at Month 24 of follow-up (P = 0.00039). Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.78 ± 0.18 (Snellen 20/120 ± 20/30) at baseline to 0.42 ± 0.17 (20/52 ± 20/30) at Month 12 (P = 0.0001) and 0.40 ± 0.17 (20/50 ± 20/30) at Month 24 of follow-up (P = 0.0002). Tocilizumab therapy was withdrawn in 5 patients with sustained remission at Month 12 but in all, ME relapsed between 1 and 3 months after TCZ discontinuation. Rechallenge of TCZ infusions led to recovery of uveitis control and ME resolution. Two adverse events were reported during two 4-month follow-ups: one Grade 1 neutropenia and one community-acquired pneumonia. In this long-term study, TCZ was effective and had a comparable safety profile to published data for TCZ use in other indications, when used for the treatment of refractory uveitis-related ME.

Requirement of longer term antiviral therapy in patients with cytomegalovirus anterior uveitis with corneal endothelial cell damage.

BackgroundThe aim of the study was to investigate the efficacy of therapy in patients with cytomegalovirus (CMV) anterior uveitis.Patients and methodsWe reviewed the records of patients with CMV anterior uveitis who attended our institution between October 2010 and December 2015 and who were confirmed to have CMV DNA in the aqueous humor by polymerase chain reaction analysis.ResultsFourteen immunocompetent patients (10 men and 4 women, total of 17 eyes) were enrolled. The mean ± SD age at the onset of antiviral therapy was 63.1 ± 11.3 years (range, 44–87 years). CMV DNA was not detected in the aqueous humor of 3 patients on initial testing, but it was detected on subsequent analysis. All patients underwent systemic antiviral therapy. Among the patients who were followed up for more than 6 months after starting systemic antiviral therapy, systemic antiviral therapy was successfully terminated in all 4 patients without corneal endothelial loss but had to be continued because of disease recurrence on its termination in 5 of 8 patients (62.5%) with corneal endothelial damage (P = 0.038).ConclusionsPatients with corneal endothelial cell loss are likely to require longer term antiviral therapy than those without endothelial damage. In addition, whereas definitive diagnosis of CMV anterior uveitis requires the detection of CMV DNA in aqueous humor by polymerase chain reaction, one-fifth of patients in the present study tested negative on initial examination.

Normalised quantitative polymerase chain reaction for diagnosis of tuberculosis-associated uveitis

Normalised quantitative polymerase chain reaction for diagnosis of tuberculosis-associated uveitis

Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil

AimsTo analyse the clinical features, systemic associations, treatment and visual outcomes of uveitis in children from a referral centre in São Paulo, Brazil.MethodsClinical records of patients under 16 years old...

Association of Gout With Uveitis in Older Individuals

This cohort study uses Medicare claims data to assess the association of gout with risk of a new diagnosis of uveitis in older individuals.

Epidemiology of uveitis in a US population-based study

BackgroundThe purpose of this study is to assess the relationship between self-reported uveitis and purported demographic and clinical risk factors, using an American adult population extracted from the National Health and Nutrition Examination Survey (NHANES) for the years 2009 and 2010. This is a cross-sectional, population-based study using a sample of 5106 subjects between 20 and 69 years old. The main outcome for our study was the self-report of a diagnosis of uveitis. The demographic analysis included age, gender, and ethnicity. Potential predictors were having a diagnosis of ankylosing spondylitis (AS), ulcerative colitis (UC), or Crohn’s disease (CD); a history of cigarette smoking; vitamin D deficiency; and different mental health measures. Univariate and multivariate analyses were conducted using RStudio.ResultsOf the 5106 participants, 27 had reported a diagnosis of uveitis, showing an adjusted prevalence of 5.4 per 1000 subjects (95% CI 3.4–8.5/1000). Increased age was associated with higher uveitis prevalence in the multivariate analysis (odds ratio [OR] = 1.04, 95% CI 1.01–1.07; p = 0.02). Positive smoking history was reported in 59.2% of patients. Multivariate analysis comparing smoking with the presence of uveitis showed an OR of 3.18 (95% CI 1.59–6.37; p = 0.003), adjusting for age and gender. Moreover, 11.1% of the participants from the uveitis group self-reported a diagnosis of AS and 11.7% informed a diagnosis of UC and 7.1% of CD. The ORs were of 16.64 (95% CI 3.64-76.09; p = 0.001), 11.34 (95% CI 2.69-47.88; p = 0.003), and 22.16 (95% CI 2.64-186.17; p = 0.007), respectively when compared with the non-uveitis group in the multivariate analysis.ConclusionsAge, cigarette smoking, AS, UC, and CD are positively associated with self-reported uveitis. There is previous evidence that smoking and female gender are positive risk factors for uveitis, as well as evidence that HLA-B27-positive spondyloarthritides have the highest association with non-infectious uveitis in the adult population in North America and Europe. However, there are no prior studies that have utilized a representative US population-based sample to validate these findings. The present study supports smoking as a risk factor, which has clinical relevance since this is a modifiable habit.

USE OF A THRESHOLD OF INTERLEUKIN-10 AND IL-10/IL-6 RATIO IN OCULAR SAMPLES FOR THE SCREENING OF VITREORETINAL LYMPHOMA

To determine a threshold for interleukin (IL)-10 and IL-10/IL-6 ratio in the aqueous humor (AH) and the vitreous for the screening of vitreoretinal lymphoma (VRL). One hundred nineteen patients for whom IL-10 and IL-6 in the AH and/or vitreous had been measured were included: 16 patients with a final diagnosis of VRL and 103 patients with final diagnosis of uveitis. Groups were compared according to IL-10 and IL-6 levels and demographic data. In patients with VRL (Group 1), mean IL-10 values were 5,636 pg/mL, and in patients with uveitis (Group 2), 6.7 pg/mL in the vitreous and 190 pg/mL in Group 1 and 8.6 pg/mL in the AH. In Group 1, the mean IL-10/IL-6 ratio was 29.02 in the vitreous and 10.9 in the AH; in Group 2, ratio was 0.1 in both humors. These values were significantly different between patients with VRL and with uveitis (P < 0.001). A cutoff of 65 pg/mL and 30 pg/mL IL-10 in the vitreous and AH, respectively, was associated with sensitivity of 93% and 78%, respectively, and specificity of 100% and 97%, respectively. A ratio higher than 1 in the vitreous had sensitivity of 93% and specificity of 100%. Vitreoretinal lymphoma diagnosis is difficult, and tools like interleukin measurements in AH and vitreous can make it easier. The use of a cutoff for IL-10 and IL-10/IL-6 ratio could allow for an earlier diagnosis that may improve prognosis.

Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative

BackgroundIn 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for...

Normalised quantitative polymerase chain reaction for diagnosis of tuberculosis-associated uveitis

Polymerase chain reaction (PCR)-based diagnosis of tuberculosis-associated uveitis (TBU) in TB-endemic countries is challenging due to likelihood of latent mycobacterial infection in both immune and non-immune cells. In this study, we investigated normalised quantitative PCR (nqPCR) in ocular fluids (aqueous/vitreous) for diagnosis of TBU in a TB-endemic population. Mycobacterial copy numbers (mpb64 gene) were normalised to host genome copy numbers (RNAse P RNA component H1 [RPPH1] gene) in TBU (n = 16) and control (n = 13) samples (discovery cohort). The mpb64:RPPH1 ratios (normalised value) from each TBU and control sample were tested against the current reference standard i.e. clinically-diagnosed TBU, to generate Receiver Operating Characteristic (ROC) curves. The optimum cut-off value of mpb64:RPPH1 ratio (0.011) for diagnosing TBU was identified from the highest Youden index. This cut-off value was then tested in a different cohort of TBU and controls (validation cohort, 20 cases and 18 controls), where it yielded specificity, sensitivity and diagnostic accuracy of 94.4%, 85.0%, and 89.4% respectively. The above values for conventional quantitative PCR (≥1 copy of mpb64 per reaction) were 61.1%, 90.0%, and 74.3% respectively. Normalisation markedly improved the specificity and diagnostic accuracy of quantitative PCR for diagnosis of TBU.

PCR Multiplex for CMV Detection in Patients with Anterior Uveitis

ABSTRACTPurpose: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU).Patients and methods: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse.Results: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner–Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode.Conclusion: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications.

Diagnostic Utility of Quantitative Polymerase Chain Reaction versus Culture in Endophthalmitis and Uveitis

ABSTRACTPurpose: To compare genetic testing for microbes in infectious endophthalmitis or uveitis to culture.Methods: This was a retrospective, single-center case series that enrolled patients with clinically suspected endophthalmitis or uveitis of unknown etiology. Aqueous humor or vitreous was collected and sent for routine cultures and genetic testing.Results: In total, 46 patients were enrolled. Genetic testing was positive in 32/46 (70%) cases and culture 6/46 cases (13%). Five of 16 uveitis cases had a final clinical diagnosis of infectious uveitis, and polymerase chain reaction (PCR) was positive in 4/5 cases (80%), versus 0% for culture. In uveitis cases, PCR was 80% sensitive and 82% specific, and culture had 0% sensitivity. The overall sensitivity and specificity of PCR for all cases were 85% and 67%, respectively, compared with 17% and 100% for culture.Conclusion: Genetic assays are inexpensive ($25/case) and more sensitive than culture for identifying intraocular pathogens in endophthalmitis and uveitis.

Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis).

ULISSE is the only study that prospectively assessed the efficiency of a standardized strategy, compared to an open strategy for the etiologic diagnosis of uveitis. Our aim was to evaluate the diagnostic yield of the tests prescribed in the ULISSE study to clarify their relevance. ULISSE is a non-inferiority, prospective, multicenter and cluster randomized study. The standardized strategy is a two-steps strategy: in the first step, common standard tests were performed, and in the second step, tests were guided by the clinical and anatomic type of uveitis. We reported the relevance of the diagnostic tests used in the standardized strategy, as well as the profitability of the tests that were prescribed to more than twenty patients in each group. Based on diagnostic criteria, either an ophthalmologist, or an internist, established the profitability of a test by considering whether the test lead to a diagnosis or not. Among the 676 patients included (standardized 303; open 373), a diagnosis was made for 152 (50.4%) in the standardized group and 203 (54.4%) in the open group. The most common entities were HLA-B27 associated uveitis (22%), spondyloarthritis (11%), sarcoidosis (18%), tuberculosis (10.7%) and herpes virus infections (8.5%). Among the first step's systematic tests, tuberculin skin test was the most contributive investigation (17.1%), followed by chest X-ray (8.4%), C reactive protein and ESR (6.6% and 5.1%), complete blood count (2.2%) and VDRL (2.0%). The second step's most often contributive tests were: HLA B27 (56.3%), chest-CT (30.3%) and angiotensin converting enzyme (ACE) (16.5%). HLA B27 and ACE were significantly more contributive in the standardized group than in the open group. Immunological tests were never contributive. Among the free investigations, or among the investigations guided by clinical or paraclinical findings, the most often contributive tests were: Quantiferon® (24%), electrophoresis of serum protein (7.8%) and sacroiliac imagery (46.4%). Intracellular serologies (1.7%), serum calcium (2.1%) and hepatic tests (3.3%) were exceptionally contributive. Among the third intention tests, labial salivary gland biopsies were contributive in 17.9% of cases, but the profitability of other invasive investigations (anterior chamber tap, vitrectomy, bronchoscopy and lumbar puncture) or specialized imagery (18F-FDG PET, Brain MRI) could not be determined since these test were rarely performed. Only a few diagnostic tests are useful for the etiological assessment of uveitis. They are often cheap, simple, more often guided by the clinical findings, and lead to an etiological diagnosis in most patients. On the other hand, some tests are never or exceptionally contributive, such as immunological tests or intracellular serologies. Further studies are required to evaluate the profitability of third intention imagery and invasive investigations.

The status and advances in the application of fundus autofluorescence in noninfectious uveitis

Noninfectious uveitis refers to a category of inflammatory diseases involving the uvea, with the exception of infectious factors or masquerade syndrome. The diagnosis and follow-up of noninfectious uveitis that involving retina or choroid require fundus imaging techniques. Fundus autofluorescence is a noninvasive imaging technique. Compared with fundus colorized photography, fundus fluorescein angiography and indocyanine green angiography, fundus autofluorescence indicates the functional status of retinal pigment epithelium and photoreceptor cells in a better way, thus playing a role in the pathophysiological mechanisms investigating, early diagnosis, disease progression monitoring and prognosis estimating of noninfectious uveitis, such as Vogt-Koyanagi-Harada disease, Behcet disease, multifocal choroiditis, punctate inner choroidopathy, birdshot chorioretinopathy, multiple evanescent white dot syndrome, acute zonal occult outer retinopathy, acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. Key words: Uveitis/diagnosis; Fluorescence; Review

Rapid Detection and Identification of Uveitis Pathogens by Qualitative Multiplex Real-Time PCR.

PurposeInfectious uveitis is a serious sight-threatening infection commonly caused by herpesviruses and Toxoplasma gondii. Etiologic diagnosis based on the clinical evaluation is often challenging. We developed and validated a multiplex real-time PCR assay coupled with high-resolution melting (HRM) for rapid detection and identification of herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), and T. gondii.MethodsThe assay was designed to target pathogen genome regions that yield products with distinct melting temperatures. Analytical specificity, sensitivity, and precision of HRM identification were determined. Clinical validation was performed by testing 108 intraocular fluids collected from eyes suffering with infectious uveitis (n = 30) and controls (n = 78).ResultsA nonoverlapping high-precision profile for each pathogen was generated following HRM (coefficient of variation 0%). The assay was highly sensitive, with a limit of detection of 20 genome copies for herpesviruses and 200 genome copies for T. gondii. The intra- and interassay variability of cycle threshold (Ct) measurement was ≤4% and ≤6%, respectively. Thirteen intraocular specimens collected from suspected cases of infectious uveitis were positive (mean Ct values varied from 19.4 to 27.7). Melting profiles of positive cases were consistent with HSV-2 (n = 5), VZV (n = 5), CMV (n = 2), and T. gondii (n = 1). Amplicon identities were confirmed by sequencing. Control intraocular samples from patients without a clinical diagnosis of infectious uveitis were all negative.ConclusionsThis assay allows rapid, sensitive, and reliable detection and identification of the most common known causes of infectious uveitis, making early pathogen information-based intervention possible.

Distinguishing Uveitis Secondary to Sarcoidosis From Idiopathic Disease

Idiopathic disease is the most frequent diagnosis in a uveitis clinic. The need to distinguish sarcoidosis from idiopathic uveitis is controversial. However, cardiac involvement in sarcoidosis can be life-threatening. To report a series of patients with uveitis and cardiac sarcoidosis to illustrate the importance of categorizing the causes of uveitis. This retrospective observational case series reviewed the medical records of 249 patients with uveitis who were referred to the Casey Eye Institute between July 1, 2008, and February 28, 2017. We describe patients who initially received a diagnosis of idiopathic uveitis but subsequently received a diagnosis of sarcoidosis. Clinical data, including ophthalmologic findings, were collected. We summarized the number of patients who initially presented with idiopathic uveitis, the number of patients who recived a classification of idiopathic uveitis after evaluation, the number of patients who underwent chest computed tomography or an electrocardiogram, and the number of patients with ocular sarcoidosis. Of 33 patients with sarcoidosis, 21 (63.6%) were women and the mean (SD) age was 53.5 (13.8) years. Of 249 patients, the referring diagnosis was idiopathic uveitis for 179 (72%). After history, examination, and laboratory testing, 127 (51%) were still considered to have idiopathic disease. Fifty-three of the 179 patients (30%) with idiopathic disease underwent chest computed tomography scanning. A diagnosis of presumed sarcoidosis, usually on the basis of a chest computed tomography scan, was made in 19 patients (36.2%). As 14 patients (5.6%) were previously known to have sarcoidosis, 33 patients (13.3%) were evaluated with definite or presumed ocular sarcoidosis. We obtained electrocardiograms as a screen for cardiac sarcoidosis on 14 (42.4%) of these patients. Nine patients with abnormal electrocardiogram results were referred to cardiologists. Four of the 19 patients (21.1%) who were referred for idiopathic uveitis but subsequently received a diagnosis of presumed sarcoidosis were found to have episodes of ventricular tachycardia that required implantable cardiac defibrillators. Distinguishing ocular sarcoidosis from idiopathic uveitis had potentially life-saving implications for these patients. The present case series shows the potential utility of distinguishing sarcoidosis-associated uveitis from idiopathic uveitis. We suggest that patients older than 40 years with a history of idiopathic uveitis be evaluated with chest computed tomography and an electrocardiogram if sarcoidosis is suggested on ophthalmic examination.

Outcome of polymerase chain reaction (PCR) analysis in 100 suspected cases of infectious uveitis

BackgroundPolymerase chain reaction (PCR) analysis is an important tool in the diagnosis of infectious uveitis. A retrospective, interventional study of PCR analysis of ocular fluid in suspected infectious uveitis cases between January 2014 to July 2016 was done. Nested, real-time and broad range PCR was performed for detection of the genome of Mycobacterium tuberculosis, herpes virus family, Chikungunya virus, Toxoplasma gondii, fungus, eubacterium and propionibacterium acne.ResultsTotal of 100 cases included, mean age was 39.2 ± 15.4 years. Uveitis was unilateral in 82% and granulomatous in 40%. Mean visual acuity at the initial visit and final visit was 0.73 logMar and 0.63 logMar respectively. PCR analysis confirmed the clinical diagnosis in 70.1% patients. The sensitivity, specificity, positive predictive value and negative predictive value of PCR analysis was 90.2%, 93.9%, 93.9% and 90.2% respectively. The quantitative value of real-time M. tb. Positive PCR ranged from 32c/ml to 2722 c/ml.ConclusionsPCR assay is an accurate technique with high sensitivity and specificity to diagnose the DNA genome in infectious uveitis.

Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers

ABSTRACTPurpose: To evaluate diagnostic methods and clinical signs of CMV anterior uveitis (AU), a rarely described entity in Europe.Methods: We included patients with clinical characteristics of CMV AU and positive PCR and/or Goldmann-Witmer coefficient (GWc) for CMV.Results: We report 21 patients with unilateral uveitis (100%) and signs of Posner-Schlossman syndrome (PSS) (n = 20, 95.2%), Fuchs uveitis syndrome (FUS) (n = 1, 4.7%), and endotheliitis (n = 4, 19,04%). PCR was positive in 15/21 (71.4%) and GWc in 8/9 patients (88.9%) in aqueous for CMV. GWc was the only positive test in 6/9 patients (66,6%). When PCR alone was performed (without GWc) in the first tap, repeated aqueous taps were needed, twice in five cases and thrice in one case.Conclusion: Combining PCR and GWc were very helpful to confirm the clinical diagnosis of CMV AU. In case of very high clinical suspicion and negative results, repeated tap seems to be recommended.