Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
Graefes Arch Clin Exp Ophthalmol. 2011 Jan;249(1):103-10. doi: 10.1007/s00417-010-1510-y. Epub 2010 Sep 21.
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.
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.
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%.
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.
前段部巨细胞病毒 (CMV) 感染可表现为前葡萄膜炎和角膜内皮炎，最近在免疫功能正常的患者中也有报道。我们希望评估两种推测的特征性临床特征的有效性：特征 1，非单纯疱疹病毒 (HSV)/水痘带状疱疹病毒 (VZV) 皮质类固醇难治性炎症性眼高压综合征 (IOHS)，和特征 2，具有特定硬币状角膜后沉着物 (KP) 的角膜内皮炎，这可能有助于识别 CMV 前段眼内感染。
2006 年 1 月 1 日至 2010 年 5 月 31 日，连续从长庚纪念医院桃园院区的葡萄膜炎服务中招募符合特征 1 或特征 2 或两者的患者。进行前房穿刺术，然后进行实时定量聚合酶链反应 (PCR) 检测疱疹病毒科 DNA，包括 HSV I 和 II、VZV、CMV 和 EBV。
本研究共纳入 30 例患者的 31 只眼（21 名男性和 9 名女性）。28 例患者的 29 只眼（20 名男性和 8 名女性）CMV DNA PCR 阳性。特征 1 中 19 只眼（19 例患者）阳性，特征 2 中 11 只眼（11 例患者）阳性。特征 1 和特征 2 的阳性预测值分别为 94.7%和 90.9%，两种特征联合的阳性预测值为 93.3%。
非 HSV/ZVZ 皮质类固醇难治性 IOHS 和具有特定硬币状 KP 的角膜内皮炎可作为 CMV 前段眼内感染的筛查工具。
