Intraocular Fluid Analysis Research Articles

Usefulness of aqueous and vitreous humor analysis in infectious uveitis

OBJECTIVE:To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis.METHODS:Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii.RESULTS:The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH.CONCLUSION:Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.

Herpetic Anterior Uveitis in a Chinese Referral Center: Clinical Manifestations and Laboratory Test Results

ABSTRACT Purpose To describe and to compare the clinical manifestation and laboratory test results of herpetic anterior uveitis (HAU) caused by Herpes simplex virus (HSV) and varicella-zoster virus (VZV). Methods A retrospective, observational study on patients diagnosed with HAU. Etiology, clinical features, ocular complications, and recurrences of the infection were evaluated as main clinical parameters. The aqueous Interleukin-8 (IL-8) level was also measured to assess the intraocular inflammation. Results Thirty-two eyes (32 patients) were involved. Among all involved cases, 24 had VZV-AU and 8 had HSV-AU. Common clinical features of HAU included the presence of KPs (90.6%), distorted pupil (83.3%), Iris atrophy (71.9%) and corneal edema (50%). The intraocular fluid analysis showed higher viral load and IL-8 level in VZV-AU. Conclusions Compared with HSV-AU, the intraocular inflammation was more severe in VZV-AU. The intraocular fluid analysis was valuable for the etiological diagnosis and the evaluation of disease severity.

Uveitis associated with Toxocara; Clinic, Diagnosis, and Treatment

Ocular toxocariasis or ocular larva migrans is a parasitic infection via the ingestion of dog nematode Toxocara canis and cat nematode Toxocara cati larvae. It usually affects only one eye of the child under the age of sixteen. The most common clinical findings in ocular toxocariasis are peripheral granuloma, posterior pole chorioretinal eosinophilic granulomas, and endophthalmitis or pars planitis. It is diagnosed with clinical findings in developing countries, ELISA antibody tests, and, if necessary, intraocular fluid analysis can be made. Ocular toxocariasis must be distinguished from retinoblastoma and other congenital and inflammatory eye conditions of childhood. In treatment, besides anthelmintic agents, steroid use and vitreoretinal surgery may be needed.

Varicella zoster virus-associated Chorioretinitis: a case report

BackgroundChorioretinitis is an unusual form of varicella zoster virus (VZV)-associated uveitis, and no report has described VZV-associated chorioretinitis using serial optical coherence tomography (OCT) images obtained during the course of resolution.Case presentationA 61-year-old woman presented with acute, unilateral vision loss in her right eye. Her visual acuity was count fingers in the right eye and 16/20 in the left eye, and she exhibited skin vesicles on her right forehead. Slit lamp biomicroscopy, funduscopy, OCT, and intraocular fluid analysis were performed. The right eye exhibited multiple inflammatory lesions at the posterior pole, macular edema, and disc swelling on the fundus examination. OCT revealed predominant involvement of the choroid and the retinal pigment epithelium (RPE). Intraocular fluid analysis showed positivity for VZV. The patient was admitted and treated with intravenous acyclovir. Additional oral prednisolone was used to reduce the inflammatory reaction. After 2 weeks of treatment with acyclovir, the lesion resolved, with undulation of the RPE. Her final visual acuity was 20/20.ConclusionsVZV-associated posterior uveitis may present as multifocal chorioretinitis. Intraocular fluid analysis is important to detect an infectious origin.

Unexplained Anterior Uveitis: Viral Causes.

Sir, Idiopathic anterior uveitis is increasingly being associated with a viral aetiology. Herpes simplex and Herpes zoster virus (HSV/HZV) are known causes of anterior uveitis but other viruses including Cytomegalovirus (CMV) and Rubella are now being recognized [1]. Viral anterior uveitis has characteristic clinical features, an understanding of which assists the examining ophthalmologist in making an appropriate diagnosis and in initiation of a timely management which varies with the viral strain. The diagnosis may be relatively straight forward in the presence of concomitant skin lesions, active keratitis, and/or corneal anaesthesia. However, in the absence of such clues, the diagnosis requires a high index of clinical suspicion and astute observations, especially as access to intraocular fluid analysis is not available to most clinicians [2]. Herpetic anterior uveitis is characterised by diffusely distributed keratic precipitates (KP), moderate inflammation, posterior synechiae and sectoral or diffuse iris atrophy [Table/Fig-1]. HSV uveitis is suggested by patchy atrophy around the pupillary sphincter [Table/Fig-2] [3]. The intraocular pressure (IOP) is usually raised. HSV usually affects a younger age group whereas HZV is more commonly seen in elderly and immunocompromised patients [4]. [Table/Fig-1]: Diffuse iris atrophic changes [Table/Fig-2]: Pupillary pigment atrophy Cytomegalovirus (CMV) anterior uveitis has few KPs, mild inflammation with raised intraocular pressure (IOP) and no posterior synechiae. The iris has a moth eaten appearance. CMV uveitis can simulate Posner-Schlossman Syndrome, Fuchs' uveitis and herpetic uveitis [5]. Rubella is characterised by posterior subscapular cataract, mild inflammation, diffuse iris atrophy, lack of posterior synechiae and mildly raised IOP. Fuch’s uveitis is now considered to be usually due to Rubella virus. Presence of cataract on presentation is highly suggestive in cases of mild anterior uveitis with raised IOP in a younger age group. In most instances the condition is benign and does not require any anti-inflammatory therapy. An appropriate diagnosis avoids unnecessary work-up and ineffective therapy. Steroids do not have much effect and should be avoided. Follow-up should be regular to monitor lens opacities and intraocular pressure [2]. In summary, in cases of unexplained anterior uveitis, a high index of suspicion regarding possible viral cause should be maintained and antiviral therapy should be considered in eyes with recalcitrant uveitis. As access to intraocular fluid analysis is not available to most clinicians, all attempts should be made to reasonably diagnose the causative virus on the basis of clinical features as a virus specific therapeutic approach is necessary along with standard anti-inflammatory, cycloplegic and antiglaucoma medications.

The diagnostic value of intraocular fluid analysis by polymerase chain reaction in Thai patients with uveitis

Uveitis is a major cause of severe visual impairment throughout the world and can be initiated by various infectious and non-infectious causes. Early recognition of specific infections is important as the treatment with antimicrobial agents might stop the progression or even cure the eye disease. To determine the infectious causes of uveitis in Thailand, intraocular fluid samples of 100 HIV-negative patients and 47 HIV-positive patients with uveitis were examined using real-time PCR analysis for herpes simplex virus, varicella zoster virus, cytomegalovirus and Toxoplasma gondii. Positive PCR results were found in 33/100 (33%) HIV-negative patients and in 33/47 (70%) HIV-positive patients with uveitis. In Thailand, cytomegalovirus was identified as the most frequent cause of infectious uveitis in both HIV-negative and HIV-positive patients (49 and 91%, respectively). PCR analysis of intraocular samples in uveitis was a valuable diagnostic assay. The pattern of uveitis observed in the Far East differs from that found in the West .

Anterior uveitis with intraocular fluid analysis positive for Rubella virus

AbstractPurpose To compare the clinical characteristics and visual prognosis of patients with anterior uveitis (AU) with intraocular fluid analysis positive for Rubella virus (RV), Herpes Simplex virus (HSV) or Varicella Zoster virus (VZV) in order to discriminate rubella virus AU from herpes virus AU.Methods Retrospective, observational study.Clinical records of 106 patients with anterior uveitis and positive Polymerase chain reaction and/ or Goldmann‐Witmer coefficients for RV (n=57), HSV (n=39) and VZV (n=10) were analyzed. Demographic constitution, ophthalmological characteristics and visual prognosis were compared.Results All three types of viral AU were characterized by unilateral involvement (80‐97%). RV‐AU was characterized by younger age at onset and chronic course, and was typically associated with cataract at presentation. Heterochromia was present in 23% of RV‐AU patients. AU associated with HSV or VZV infection occurred characteristically in older patients and frequently followed an acute course. Associated clinical features included conjunctival redness, corneal edema, history of keratitis and development of posterior synechiae. HSV‐AU had more often severe AU whereas the presence of vitritis was more common in RV‐AU and VZV‐AU. The prevalence of documented IOP above 30mm Hg (25‐50%, P=0.06) and development of glaucoma (18‐30%, P=0.687) were similar in all three groups. Retinal scarring was seen in 22% of RV‐AU eyes, 0% HSV‐AU eyes and in 11% of VZV‐AU eyes Visual prognosis was favorable for all three groups.Conclusion Our results point out clinical differences between RV‐AU, HSV‐AU and VZV‐AU and might be especially of value to ophthalmologists who lack the possibility of intraocular fluids analysis to discriminate rubella virus AU from herpes virus AU.

Comparison of Rubella Virus- and Herpes Virus-Associated Anterior Uveitis: Clinical Manifestations and Visual Prognosis

To compare the clinical characteristics and visual prognosis of patients with anterior uveitis (AU) and intraocular fluid analysis positive for rubella virus (RV), herpes simplex virus (HSV), or varicella zoster virus (VZV). Retrospective, observational study. The study included 106 patients with AU and positive polymerase chain reaction (PCR) results, Goldmann-Witmer coefficients (GWCs), or both, for RV (n = 57), HSV (n = 39), or VZV (n = 10). Clinical records of the included patients were analyzed retrospectively; demographic constitution, ophthalmologic characteristics, and visual prognosis were compared. Age, gender, and diverse clinical and laboratory characteristics, including course and laterality of AU; prevalence of positive results for PCR, GWC, or both; conjunctival redness; corneal edema; history of keratitis; presence of keratic precipitates; synechiae; heterochromia; and grade of inflammation. In addition, complications and visual acuity at 1 and 3 years of follow-up were recorded. All 3 types of viral AU were characterized by unilateral involvement (80%-97%). Rubella virus AU was characterized by younger age at onset and chronic course and typically was associated with cataract at presentation. Heterochromia was present in 23% of RV AU patients. Anterior uveitis associated with HSV or VZV occurred characteristically in older patients and frequently followed an acute course. Clinical features associated with herpetic AU included conjunctival redness, corneal edema, history of keratitis, and development of posterior synechiae. Herpes simplex virus AU often had severe anterior chamber inflammation, whereas the presence of vitritis was more common in RV AU and VZV AU. The prevalence of documented intraocular pressure (IOP) of more than 30 mmHg (25%-50%; P = 0.06) and development of glaucoma (18%-30%; P = 0.686) were similar in all 3 groups. Focal chorioretinal scars were seen in 22% of RV AU eyes, in 0% of HSV AU eyes, and in 11% of VZV AU eyes (P = 0.003). Visual prognosis was favorable for all 3 groups. These observations identify clinical differences between RV AU, HSV AU, and VZV AU and may be of particular value to ophthalmologists who are unable to carry out intraocular fluid analysis to discriminate between these types of viral AU. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Pseudo-Hypopyon as the Presenting Feature of Recurrent B-Cell Lymphoma

Purpose: To report a case of a pseudo-hypopyon as the presentation for recurrent B-cell lymphoma. Design: Case report. Methods: Case report with anterior segment photograph. Results: A 74-year-old man with past medical history of peripheral B-cell lymphoma developed a hypopyon 3 months after R-CHOP chemotherapy and prophylactic intrathecal chemotherapy. Anterior chamber aspirate was consistent with B-cell lymphoma. Conclusions: Pseudo-hypopyon as a manifestation of recurrent B-cell lymphoma is a rare clinical presentation of an intraocular malignancy. A high index of suspicion along with intraocular fluid analysis are essential to establish the diagnosis.

Uveitis masquerade syndromes

Background Incorrect diagnosis of the uveitic masquerade syndromes (UMS) may have severe consequences. In this study, the frequency, clinical manifestations, and informative diagnostic tests for UMS are described. Design Retrospective observational case series. Participants Forty patients with UMS were identified in a cohort of 828 consecutive patients with uveitis. The mean follow-up was 4.5 years. Methods A review of clinical, laboratory, photographic, and angiographic records was performed. Main outcome measures Clinical features, associated systemic diseases, diagnostic procedures and their role in the diagnostic process, and systemic and visual outcomes. Results Nineteen patients had intraocular malignancy (48% of all with UMS; 2.3% of all with uveitis), mainly intraocular lymphoma (n = 13) and leukemia (n = 3). The ophthalmologist was the first to recognize malignant disease in 11 of 19 patients (58%). Of 21 patients with nonmalignant UMS, 10 had an ocular vascular disease and 5 a hereditary ocular disorder. The patients with malignant UMS were older than those with nonmalignant UMS (average age, 50 vs 44 years, P < 0.05). During follow-up, 9 of 19 patients with malignant UMS died. The most informative diagnostic procedure for malignant UMS was intraocular fluid analysis; for nonmalignant UMS, fluorescein angiography. The cytologic analysis of intraocular fluids yielded the best results for diagnosing intraocular malignancies (7 of 11 patients, 64%); the association of negative cytologic results with the recent administration of systemic corticosteroids was noted. Immunophenotyping of the aqueous confirmed the diagnosis of hematologic malignancy for 3 of 5 patients examined. Panuveitis was the most frequent manifestation of malignant UMS. Intraocular lymphomas presented with isolated vitreitis (n = 6), chorioretinal lesions (n = 5) and iris infiltration (n = 2). Clinical presentation of nonmalignant UMS was diverse but consisted mainly of abnormalities of the retinal vasculature. Conclusions UMS was diagnosed in 5% of the patients with uveitis at a tertiary center. Despite the variety of underlying disorders and different clinical presentations, a high frequency of malignant and vascular diseases was found. Awareness of the clinical manifestations of UMS and application of the correct diagnostic procedures should promote timely diagnosis and treatment, which are essential not only for visual acuity but also for the life of the patient.

Diagnostic and therapeutic dilemmas in ocular toxoplasmosis

Ocular toxoplasmosis, a leading cause of visual handicaps in young people, represents a late manifestation of congenital infection in the majority of cases. Ocular involvement in acquired toxoplasmosis has been repeatedly reported and shows that toxoplasmic retinitis may develop in the wake of acquired infection. The diagnosis of ocular toxoplasmosis is mainly clinical since serologic tests are positive for a considerable percentage of the general population and are not indicative for ocular involvement. The demonstration of local synthesis of toxoplasma antibodies in the eye by intraocular fluid analysis is a valuable diagnostic tool. The application of the polymerase chain reaction, in which the parasite's DNA is detected, may be expected to change the diagnostic repertoire drastically in the future. The need for appropriate therapy for patients with ocular toxoplasmosis is a matter of continued debate: the majority of the medications used for treatment have potentially serious side effects and the efficacy of treatments has not been clarified in previous studies. Recently, a prospective multicenter study to evaluate the efficacy of current therapeutic strategies for ocular toxoplasmosis was performed in The Netherlands and included 106 patients with active ocular toxoplasmosis. The principal conclusion of this study is that only drug therapy with pyrimethamine had any perceptible influence on any aspect of ocular toxoplasmosis, but this effect may not be worth the risk of side effects except in fovea threatening lesions.