Cytomegalovirus Implicated in Some Anterior Uveitis

Cytomegalovirus or CMV’s an etiological factor in patients with hypertensive anterior uveitis in Korea, according to a recent study.

The paper, authored by Jin Choi, department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, and colleagues, appeared in the September issue of the Journal of Ophthalmic Inflammation and Infection.

This was a retrospective review of patients with anterior hypertensive uveitis who were investigated at Seoul St. Mary’s Hospital from March 2009 to June 2014. This study was performed according to the tenets of the Declaration of Helsinki, and the study protocol was approved by the institutional review/ethics boards of the Seoul St. Mary’s Hospital, the Catholic University of Korea.

All of the patients included in this study met the following criteria: (1) anterior uveitis with keratic precipitates (KPs) and (2) increased intraocular pressure (IOP). Patients with the following were excluded: (1) presence of inflammation in vitreous or retina and (2) presence of corneal endothelial changes for a known cause other than anterior uveitis.

Participants underwent a comprehensive ophthalmic examination, including a detailed review of medical and ocular histories, best-corrected visual acuity measurement, slit-lamp biomicroscopy, Goldmann applanation tonometry, specular microscopy using a non-contact specular microscope, dilated stereoscopic examination of the optic nerve head and fundus, stereoscopic optic disc photography and red-free retinal nerve fiber layer (RNFL) photography and optical coherence tomography scans to measure peripapillary RNFL thickness.

It was determined three times at 256 points around a set diameter (3.4 mm) circle using the fast RNFL program. Only well-focused, well-centered images without eye movement and a signal strength ≥7 were used.

Among the 42 patients with hypertensive anterior uveitis, aqueous sampling was performed in 21. Using a 30-gauge needle, 100 μL aqueous humor was aspirated under aseptic conditions and subjected to a polymerase chain reaction (PCR) assay for CMV, HSV1, and HSV2 DNA. DNA was extracted from the aqueous humor samples using a QIAamp DNA minikit (Qiagen, Valencia, CA, USA). Quantitative CMV-DNA PCR testing was performed using an AccuPower CMV Quantitative PCR Kit (Bioneer, Daejun, Republic of Korea). For HSV PCR, the HSV 1/2 PCR Kit (Bio-Core, Seoul, Republic of Korea) was used.

Patients were classified according to the duration of active intraocular inflammation. Patients with at least three months of active intraocular inflammation were considered to have chronic uveitis, and other patients to have recurrent episode of acute uveitis, which was normalized between attacks.

“The aims of this study are to investigate the clinical characteristics of patients with anterior hypertensive uveitis and compare the characteristics between patients in CMV-positive and CMV-negative groups in their aqueous humor samples,” said Choi. Special caution is needed for patients with CMV-induced hypertensive anterior uveitis, considering its adverse effect on the corneal endothelium, she added.

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