Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients.
OBJECTIVE
To describe 7 cases of unilateral, chronic and/or recurrent anterior uveitis caused by cytomegalovirus (CMV) in immunocompetent patients; to identify specific ophthalmologic characteristics; and to evaluate the clinical effect of valganciclovir treatment.


METHODS
Retrospective observational case series.


METHODS
Immunocompetent patients (n = 7) with a history of chronic and/or recurrent unilateral anterior uveitis and a positive analysis for either CMV-DNA and/or antibodies against CMV in their aqueous humor (Goldmann-Witmer coefficient > 3).


METHODS
Full ophthalmologic examination, anterior chamber fluid analysis, serologic examination, and systemic evaluation. Treatment modalities included topical steroids, topical and/or systemic antiglaucoma medications, glaucoma surgery, and systemic valganciclovir.


METHODS
Visual acuity, inflammation, and intraocular pressure (IOP).


RESULTS
Chronic unilateral anterior uveitis was seen in 6 patients, whereas recurrent uveitis was observed in 1. Additional findings consisted of slight iris atrophy and secondary glaucoma (n = 3), secondary glaucoma without iris abnormalities (n = 3), and a slightly elevated IOP without iris abnormalities (n = 1). Examinations of the aqueous humor by polymerase chain reaction demonstrated CMV-DNA in 6 patients and were negative for other herpes viruses in all. Goldmann-Witmer coefficients were strongly positive in 4 out of 5 patients. Other laboratory investigations were within normal limits. No other causes for uveitis were identified. Because of the insufficient effect of topical steroids and antiglaucoma medications, 5 patients were treated with additional oral valganciclovir with good clinical response in terms of uveitis activity and IOP. Discontinuation of valganciclovir in 1 patient resulted in a prompt recurrence of uveitis activity.


CONCLUSIONS
Cytomegalovirus may cause a chronic and/or recurrent anterior uveitis in otherwise healthy patients. Iris atrophy and glaucoma may accompany it, but an inflammatory reaction in the anterior chamber may be the only sign. Aqueous humor analysis is of the utmost importance in differentiating between CMV and other herpes viruses and in making a definite diagnosis in chronic anterior uveitis. Valganciclovir may be very effective in treating CMV anterior uveitis, but its exact role can only be determined in larger studies with a longer follow-up.
van Boxtel
Lonneke A A
LA
Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
van der Lelij
Allegonda
A
van der Meer
Johannes
J
Los
Leonoor I
LI
D000328:Adult; D000867:Anterior Chamber / Q000473:pathology; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000737:chemistry; D001284:Atrophy; D002648:Child; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D005901:Glaucoma / Q000209:etiology; D006801:Humans; D007121:Immunocompetence; D007429:Intraocular Pressure; D007498:Iris / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014606:Uveitis, Anterior / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000821:virology*; D000077562:Valganciclovir; D014792:Visual Acuity
D000998:Antiviral Agents; D004279:DNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir