title: The association of prior cytomegalovirus infection with neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To determine if prior exposure to pathogens associated with vascular disease, cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori correlates with neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  An experimental study.
  
  
  METHODS
  
  
  
  METHODS
  Institutional. Bascom Palmer Eye Institute, October 2001 to December 2002.
  
  
  METHODS
  150 patients (47 neovascular amd, 36 dry amd, and 67 non-amd controls) were included in the study. exclusion criteria included hiv infection, malignancy, recent acute illness requiring hospitalization within 6 months, or immunosuppressive illness.
  
  
  METHODS
  Serum samples were obtained for analysis of cytomegalovirus, chlamydia pneumoniae, and helicobacter pylori igg antibody titers by elisa.
  
  
  METHODS
  Comparison of the distribution of igg titers between patients with wet amd, dry amd, and controls.
  
  
  RESULTS
  The average cytomegalovirus IgG titer was higher in patients with wet AMD versus controls (p = 0.02, Student t-test, two-tailed) and patients with dry AMD (p = 0.06). Twenty-six (55%) of 47 subjects with wet AMD had high cytomegalovirus IgG titers compared with 14 (39%) of 36 patients with dry AMD (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 0.77 to 6.44) and 23 (34%) of 67 control patients (OR = 2.49, 95% CI = 0.98 to 6.33). There was no major difference in the distribution of titers for Chlamydia pneumoniae IgG and Helicobacter pylori IgG in wet and dry AMD patients. Five of 47 patients with wet AMD (11%) had high antibody titers to all three pathogens, compared with only 1 of 36 patients with dry AMD (3%) (OR = 4.17, 95% CI = 0.46 to 37.36).
  
  
  CONCLUSIONS
  There was a significant association of high cytomegalovirus IgG titer with neovascular AMD compared with dry AMD and control patients. Chronic infection with cytomegalovirus may be a novel risk factor for the progression from dry to neovascular AMD.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA. dmiller3@med.miami.edu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Miller
authors.forename: Diego G
authors.initials: DG
authors.lastname: Espinosa-Heidmann
authors.forename: Jessica
authors.initials: J
authors.lastname: Legra
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Sũner
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sedmak
authors.forename: Richard D
authors.initials: RD
authors.lastname: Dix
authors.forename: Scott W
authors.initials: SW
authors.lastname: Cousins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D020256:Choroidal Neovascularization / Q000276:immunology / Q000821:virology*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000821:virology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008268:Macular Degeneration / Q000276:immunology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D007074:Immunoglobulin G