van Boxtel Lonneke A A, van der Lelij Allegonda, van der Meer Johannes, Los Leonoor I
Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ophthalmology. 2007 Jul;114(7):1358-62. doi: 10.1016/j.ophtha.2006.09.035. Epub 2007 Feb 12.
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.
Retrospective observational case series.
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).
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.
Visual acuity, inflammation, and intraocular pressure (IOP).
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.
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.
描述7例免疫功能正常患者中由巨细胞病毒（CMV）引起的单侧、慢性和/或复发性前葡萄膜炎；确定其特定的眼科特征；并评估缬更昔洛韦治疗的临床效果。
回顾性观察病例系列。
免疫功能正常的患者（n = 7），有慢性和/或复发性单侧前葡萄膜炎病史，且房水（戈德曼-维特默系数> 3）中CMV-DNA和/或抗CMV抗体分析呈阳性。
全面的眼科检查、前房液分析、血清学检查和全身评估。治疗方式包括局部使用类固醇、局部和/或全身抗青光眼药物、青光眼手术以及全身使用缬更昔洛韦。
视力、炎症和眼压（IOP）。
6例患者出现慢性单侧前葡萄膜炎，1例为复发性葡萄膜炎。其他发现包括轻度虹膜萎缩和继发性青光眼（n = 3）、无虹膜异常的继发性青光眼（n = 3）以及无虹膜异常的眼压轻度升高（n = 1）。通过聚合酶链反应对房水进行检测，6例患者检测到CMV-DNA，所有患者对其他疱疹病毒检测均为阴性。5例患者中有4例戈德曼-维特默系数呈强阳性。其他实验室检查结果均在正常范围内。未发现葡萄膜炎的其他病因。由于局部类固醇和抗青光眼药物效果不佳，5例患者加用口服缬更昔洛韦治疗，在葡萄膜炎活动度和眼压方面取得了良好的临床反应。1例患者停用缬更昔洛韦后，葡萄膜炎活动迅速复发。
巨细胞病毒可能在其他方面健康的患者中引起慢性和/或复发性前葡萄膜炎。可能伴有虹膜萎缩和青光眼，但前房内的炎症反应可能是唯一的体征。房水分析对于区分CMV和其他疱疹病毒以及对慢性前葡萄膜炎做出明确诊断至关重要。缬更昔洛韦在治疗CMV前葡萄膜炎方面可能非常有效，但其确切作用只能在更长随访期的更大规模研究中确定。
