Tokyo Metropolitan Geriatric Medical Center, Tokyo (Y.T, J.N); Miyata Eye Hospital, Miyakonojo, Miyazaki (Y.T, K.M, M.M).
Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo (T.K, M.F).
Am J Ophthalmol. 2021 Jul;227:191-200. doi: 10.1016/j.ajo.2021.03.020. Epub 2021 Mar 25.
To determine distinguishing features of the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV).
Retrospective, multicenter case series.
Consecutive patients with herpetic AU examined at 11 tertiary centers in Japan between January 2012 and December 2017 and who were followed for ≥3 months were evaluated. Diagnosis was made by polymerase chain reaction (PCR) for HSV, VZV, or CMV in the aqueous humor, or classical signs of herpes zoster ophthalmicus.
This study enrolled 259 herpetic AU patients, including PCR-proven HSV-AU (30 patients), VZV-AU (50), and CMV-AU (147), and herpes zoster ophthalmicus (32). All HSV-AU and VZV-AU patients were unilateral, while 3% of CMV-AU patients were bilateral. Most HSV-AU and VZV-AU patients were sudden onset with an acute clinical course, while CMV-AU had a more insidious onset and chronic course. There were no significant differences for all surveyed symptoms, signs, and complications between HSV-AU and VZV-AU. However, significant differences were detected for many items between CMV-AU and the other two herpetic AU types. Ocular hyperemia and pain, blurring of vision, ciliary injection, medium-to-large keratic precipitates (KPs), cells and flare in the anterior chamber, and posterior synechia significantly more often occurred in HSV-AU and VZV-AU vs CMV-AU. In contrast, small KPs, coin-shaped KPs, diffuse iris atrophy, elevated intraocular pressure, and glaucoma surgery were significantly more frequent in CMV-AU vs HSV-AU and VZV-AU.
This multicenter, retrospective study identified distinguishing features of HSV-AU, VZV-AU, and CMV-AU.
确定单纯疱疹病毒（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）临床特征的鉴别特征。
回顾性、多中心病例系列研究。
评估 2012 年 1 月至 2017 年 12 月期间在日本 11 个三级中心接受疱疹性 AU 检查且随访时间≥3 个月的连续患者。通过聚合酶链反应（PCR）在房水中检测 HSV、VZV 或 CMV 或经典的带状疱疹眼症进行诊断。
本研究纳入了 259 例疱疹性 AU 患者，包括经 PCR 证实的 HSV-AU（30 例）、VZV-AU（50 例）和 CMV-AU（147 例）和带状疱疹眼症（32 例）。所有 HSV-AU 和 VZV-AU 患者均为单侧，而 3%的 CMV-AU 患者为双侧。大多数 HSV-AU 和 VZV-AU 患者为急性起病，病程急骤，而 CMV-AU 起病隐匿，病程慢性。HSV-AU 和 VZV-AU 患者的所有调查症状、体征和并发症均无显著差异。然而，CMV-AU 与其他两种疱疹性 AU 类型之间存在许多项目的显著差异。HSV-AU 和 VZV-AU 患者更常出现眼部充血和疼痛、视力模糊、睫状充血、中等至大的角膜后沉淀物（KP）、前房细胞和闪光以及后粘连。相比之下，CMV-AU 患者更常出现小 KP、硬币状 KP、弥漫性虹膜萎缩、眼内压升高和青光眼手术。
这项多中心回顾性研究确定了 HSV-AU、VZV-AU 和 CMV-AU 的鉴别特征。
