Sakai Jun-Ichi, Usui Yoshihiko, Suzuki Jun, Kezuka Takeshi, Goto Hiroshi
Department of Ophthalmology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Int Ophthalmol. 2019 Dec;39(12):2785-2795. doi: 10.1007/s10792-019-01125-5. Epub 2019 May 27.
To compare the clinical findings in patients with anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV).
We retrospectively analyzed the clinical profiles of HSV-AU (14 patients), VZV sine herpete (ZSH-AU: 21 patients), and CMV-AU (17 patients) diagnosed by the detection of corresponding viral DNA in aqueous humor samples by polymerase chain reaction. Further, five patients with Posner-Schlossman (P-S) syndrome were selected as controls for CMV-AU.
Patients with CMV-AU were predominately male or older in age, and all cases were unilateral except for three patients with CMV-AU. Mutton-fat keratic precipitates (KPs) were found mostly in patients with HSV-AU and ZSH-AU. Severities of AU and viral load were the highest in ZSH-AU, followed by HSV-AU and CMV-AU. Iris atrophy was observed in HSV-AU (50%) and ZSH-AU (76%), with typical morphology of round type and sector type, respectively. In patients with CMV-AU, a ring-shaped KP was found in 53% patients, 76% of whom showed a decreased number of corneal endothelial cells. CMV was not detected in the aqueous humor of patients with typical P-S syndrome.
Clinical findings of HSV-AU and VZV-AU were similar; however, more inflammatory findings were observed in VZV-AU. Iris atrophy morphologically differed in HSV-AU and VZV-AU. Inflammatory findings in CMV-AU were mild, and clinical features of iritis differed from those of the two former groups. A difference in the etiology between CMV-AU and P-S syndrome was observed.
比较由单纯疱疹病毒（HSV）、水痘带状疱疹病毒（VZV）和巨细胞病毒（CMV）引起的前葡萄膜炎（AU）患者的临床特征。
我们回顾性分析了通过聚合酶链反应检测房水样本中相应病毒DNA诊断出的HSV-AU（14例患者）、无疱疹的VZV（ZSH-AU：21例患者）和CMV-AU（17例患者）的临床资料。此外，选择5例波斯纳-施洛斯曼（P-S）综合征患者作为CMV-AU的对照。
CMV-AU患者以男性或年龄较大者为主，除3例CMV-AU患者外，所有病例均为单侧。羊脂状角膜后沉着物（KPs）多见于HSV-AU和ZSH-AU患者。AU的严重程度和病毒载量在ZSH-AU中最高，其次是HSV-AU和CMV-AU。HSV-AU（50%）和ZSH-AU（76%）观察到虹膜萎缩，其典型形态分别为圆形和扇形。在CMV-AU患者中，53%的患者发现环形KP，其中76%的患者角膜内皮细胞数量减少。典型P-S综合征患者的房水中未检测到CMV。
HSV-AU和VZV-AU的临床特征相似；然而，VZV-AU中观察到更多的炎症表现。HSV-AU和VZV-AU的虹膜萎缩形态不同。CMV-AU的炎症表现较轻，虹膜炎的临床特征与前两组不同。观察到CMV-AU和P-S综合征在病因上存在差异。
