Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
Ophthalmology. 2011 Oct;118(10):1905-10. doi: 10.1016/j.ophtha.2011.03.033. Epub 2011 Jul 20.
To compare the clinical characteristics and visual prognosis of patients with anterior uveitis (AU) and intraocular fluid analysis positive for rubella virus (RV), herpes simplex virus (HSV), or varicella zoster virus (VZV).
Retrospective, observational study.
The study included 106 patients with AU and positive polymerase chain reaction (PCR) results, Goldmann-Witmer coefficients (GWCs), or both, for RV (n = 57), HSV (n = 39), or VZV (n = 10).
Clinical records of the included patients were analyzed retrospectively; demographic constitution, ophthalmologic characteristics, and visual prognosis were compared.
Age, gender, and diverse clinical and laboratory characteristics, including course and laterality of AU; prevalence of positive results for PCR, GWC, or both; conjunctival redness; corneal edema; history of keratitis; presence of keratic precipitates; synechiae; heterochromia; and grade of inflammation. In addition, complications and visual acuity at 1 and 3 years of follow-up were recorded.
All 3 types of viral AU were characterized by unilateral involvement (80%-97%). Rubella virus AU was characterized by younger age at onset and chronic course and typically was associated with cataract at presentation. Heterochromia was present in 23% of RV AU patients. Anterior uveitis associated with HSV or VZV occurred characteristically in older patients and frequently followed an acute course. Clinical features associated with herpetic AU included conjunctival redness, corneal edema, history of keratitis, and development of posterior synechiae. Herpes simplex virus AU often had severe anterior chamber inflammation, whereas the presence of vitritis was more common in RV AU and VZV AU. The prevalence of documented intraocular pressure (IOP) of more than 30 mmHg (25%-50%; P = 0.06) and development of glaucoma (18%-30%; P = 0.686) were similar in all 3 groups. Focal chorioretinal scars were seen in 22% of RV AU eyes, in 0% of HSV AU eyes, and in 11% of VZV AU eyes (P = 0.003). Visual prognosis was favorable for all 3 groups.
These observations identify clinical differences between RV AU, HSV AU, and VZV AU and may be of particular value to ophthalmologists who are unable to carry out intraocular fluid analysis to discriminate between these types of viral AU.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
比较聚合酶链反应（PCR）阳性、Goldmann-Witmer 系数（GWC）阳性或两者皆阳性的前葡萄膜炎（AU）患者的临床特征和视觉预后，这些患者的眼内液分析结果分别为风疹病毒（RV）、单纯疱疹病毒（HSV）或水痘-带状疱疹病毒（VZV）感染。
回顾性、观察性研究。
该研究纳入了 106 例 AU 患者，他们的 AU 患者的 PCR 结果、Goldmann-Witmer 系数（GWC）或两者均为阳性，这些患者的 AU 病因分别为 RV（n = 57）、HSV（n = 39）或 VZV（n = 10）。
对纳入患者的临床记录进行回顾性分析；比较患者的人口统计学特征、眼部特征和视觉预后。
年龄、性别和各种临床及实验室特征，包括 AU 的病程和侧别；PCR、GWC 或两者阳性的发生率；结膜充血；角膜水肿；角膜炎史；角膜后沉着物；虹膜后粘连；虹膜异色；炎症分级。此外，还记录了随访 1 年和 3 年时的并发症和视力。
所有 3 种病毒性 AU 均表现为单侧受累（80%-97%）。风疹病毒 AU 具有发病年龄较小、慢性病程的特点，且常伴有白内障。23%的 RV AU 患者出现虹膜异色。HSV 或 VZV 相关 AU 主要发生于老年患者，常呈急性病程。与单纯疱疹性 AU 相关的临床特征包括结膜充血、角膜水肿、角膜炎史和后粘连形成。单纯疱疹性 AU 常伴有严重的前房炎症，而 RV AU 和 VZV AU 中更常见的是玻璃体炎。3 组患者中眼压（IOP）>30mmHg（25%-50%；P = 0.06）和青光眼（18%-30%；P = 0.686）的发生率相似。22%的 RV AU 眼出现局灶性脉络膜视网膜瘢痕，0%的 HSV AU 眼出现局灶性脉络膜视网膜瘢痕，11%的 VZV AU 眼出现局灶性脉络膜视网膜瘢痕（P = 0.003）。所有 3 组的视觉预后均良好。
这些观察结果确定了 RV AU、HSV AU 和 VZV AU 之间的临床差异，对于无法进行眼内液分析以区分这些类型的病毒性 AU 的眼科医生可能具有特别的价值。
作者没有与本文讨论的任何材料有关的专有或商业利益。
