The validity of clinical feature profiles for cytomegaloviral anterior segment infection.
BACKGROUND
Anterior segment cytomegalovirus (CMV) infection, which can be presented as anterior uveitis and corneal endotheliitis, has recently been reported in immunocompetent patients. We would like to access the validity of two presumed characteristic clinical profiles: profile 1, non-herpes simplex virus (HSV)/varicella zoster virus (VZV) corticosteroid-recalcitrant inflammatory ocular hypertensive syndrome (IOHS), and profile 2, corneal endotheliitis with specific coin-shaped keratic precipitates (KPs), that could be helpful in identifying CMV anterior segment intraocular infection.


METHODS
Patients with either profile 1 or profile 2 or both were enrolled consecutively from the uveitis service in Chang Gung Memorial Hospital, Taoyuan, between January 1, 2006 and May 31, 2010. Diagnostic anterior chamber tapping was performed and followed by real-time quantitative polymerase chain reaction (PCR) to detect herpesviridae DNA including HSV I and II, VZV, CMV, and Epstein-Barr virus.


RESULTS
Thirty-one eyes of 30 patients (21 males and nine females) were enrolled in this study. CMV DNA PCR was positive in 29 eyes of 28 patients (20 males and eight females). Nineteen of 20 eyes (19 patients) in profile 1 had positive CMV PCR. Ten of 11 eyes (11 patients) in profile 2 had positive CMV PCR. The positive predictive value of profile 1 and profile 2 was 94.7% and 90.9%, respectively. The positive predictive value of combining the two profiles was 93.3%.


CONCLUSIONS
Non-HSV/ZVZ corticosteroid-recalcitrant IOHS and corneal endotheliitis with specific coin-shaped KPs could be used as the screening tool for CMV anterior segment intraocular infection.
Hwang
Yih-Shiou
YS
Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
Shen
Chia-Rui
CR
Chang
Shirley H L
SH
Lai
Chi-Chun
CC
Liu
Chao-Lin
CL
Chen
Kuan-Jen
KJ
Lin
Ken-Kuo
KK
Chen
Tun-Lu
TL
Hsiao
Ching-Hsi
CH
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000821:virology*; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D005189:False Positive Reactions; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000077562:Valganciclovir
D004279:DNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir