Kinetics of aqueous flare, intraocular pressure and virus-DNA copies in a patient with cytomegalovirus iridocyclitis without retinitis.
BACKGROUND
A case report of recurrent unilateral granulomatous iridocyclitis with ocular hypertension without retinitis caused by cytomegalovirus (CMV) in an immunocompetent patient.


METHODS
Aqueous humor was analysed by multiplex PCR to detect viral DNA, and real-time PCR was used to evaluate virus copies before and after anti-virus treatments. Inflammation of the anterior chamber was evaluated by a laser flare photometry.


RESULTS
Genomic DNA of CMV - but not of other herpes viruses - was detected in the aqueous humor. Quantitative real-time PCR revealed 2.3 x 10(5) copies/ml of CMV DNA from the specimen. Oral valganciclovir was added to the ongoing treatment, which consisted of topical corticosteroid, timolol and latanoprost as well as systemic acetazolamide, resulting in the reduction of aqueous flare correlated with the reduction of virus copies in aqueous humor.


CONCLUSIONS
In this case of CMV-related iridocyclitis in an immunocompetent patient, specific additional anti-viral therapy was effective in controlling inflammation of anterior chamber but, as is so often the case, it was unable to control intraocular pressure. We show that inflammatory activity correlated well with the number of virus copies in the aqueous humor.
Kawaguchi
Tatsushi
T
Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan. kouseidon2002@yahoo.co.jp
Sugita
Sunao
S
Shimizu
Norio
N
Mochizuki
Manabu
M
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology*; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics*; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D015590:Fluorophotometry; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D018628:Gene Dosage; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007429:Intraocular Pressure; D015863:Iridocyclitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008297:Male; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D016133:Polymerase Chain Reaction; D012173:Retinitis / Q000821:virology; D000077562:Valganciclovir
D000959:Antihypertensive Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D000077562:Valganciclovir; D015774:Ganciclovir