Francis I. Proctor Foundation, University of California, San Francisco.
Department of Ophthalmology, University of California, San Francisco.
JAMA Ophthalmol. 2019 Apr 1;137(4):435-438. doi: 10.1001/jamaophthalmol.2018.6185.
Metagenomic deep sequencing (MDS) demonstrates that persistent and active rubella virus (RV) infection is associated with Fuchs heterochromic iridocyclitis (FHI).
To assess the utility of MDS in identifying RV infection in patients with uveitis.
DESIGN, SETTING, AND PARTICIPANTS: This case series assessed 6 patients diagnosed by MDS with RV-associated uveitis at a tertiary uveitis referral center in the United States.
Prior RV infection.
Clinical examination findings, slitlamp photography, corneal confocal imaging, and infectious pathogen genome obtained from RNA sequencing.
Six white men (age range, 36-61 years) were diagnosed with RV-associated uveitis by MDS. Three patients exhibited iris heterochromia associated with their uveitis in classic FHI fashion. The other 3 patients had less classic FHI features and exhibited anterior vitritis. Three patients had in vivo corneal confocal microscopy, with 2 demonstrating stellate keratic precipitates in addition to endothelial infiltration, spotlike holes, and enlarged intercellular boundaries. Of these 3 patients, 1 patient exhibited polymorphism and polymegathism of the endothelial cells.
These findings suggest that persistent RV infection is associated with recurrent or chronic anterior or anterior-intermediate uveitis as well as corneal endothelial cell damage. Ophthalmologists should consider RV infection as a potential cause of hypertensive anterior and intermediate uveitis.
宏基因组深度测序（MDS）表明，持续性和活跃性风疹病毒（RV）感染与 Fuchs 异色性虹膜炎（FHI）有关。
评估 MDS 在识别葡萄膜炎患者中 RV 感染的效用。
设计、设置和参与者：这项病例系列研究在美国的一家三级葡萄膜炎转诊中心评估了 6 名通过 MDS 诊断为 RV 相关葡萄膜炎的患者。
先前的 RV 感染。
临床检查结果、裂隙灯照相、角膜共聚焦成像和从 RNA 测序获得的传染性病原体基因组。
MDS 诊断出 6 名白人男性（年龄 36-61 岁）患有 RV 相关葡萄膜炎。3 名患者表现出与他们葡萄膜炎相关的虹膜异色，具有经典 FHI 特征。另外 3 名患者的 FHI 特征不那么典型，表现为前葡萄膜炎。3 名患者进行了活体角膜共聚焦显微镜检查，其中 2 名患者除了内皮浸润、点状孔和扩大的细胞间边界外，还表现出星状角膜沉淀物。这 3 名患者中，1 名患者表现出内皮细胞的多形性和多核性。
这些发现表明，持续性 RV 感染与复发性或慢性前或前间质性葡萄膜炎以及角膜内皮细胞损伤有关。眼科医生应将 RV 感染视为高血压性前和中间葡萄膜炎的潜在原因。
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