Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
Viruses. 2023 Jan 9;15(1):185. doi: 10.3390/v15010185.
Little is known regarding anterior uveitis (AU), the most common ocular disease associated with cytomegalovirus (CMV) infection in immunocompetent populations. CMV AU is highly prevalent in Asia, with a higher incidence in men. Clinically, it manifests mainly as anterior chamber inflammation and elevated intraocular pressure (IOP). Acute CMV AU may resemble Posner-Schlossman syndrome with its recurrent hypertensive iritis, while chronic CMV AU may resemble Fuchs uveitis because of its elevated IOP. Without prompt treatment, it may progress to glaucoma; therefore, early diagnosis is critical to prognosis. Knowledge regarding clinical features and aqueous humor analyses can facilitate accurate diagnoses; so, we compared and summarized these aspects. Early antiviral treatment reduces the risk of a glaucoma surgery requirement, and therapeutic effects vary based on drug delivery. Both oral valganciclovir and topical ganciclovir can produce positive clinical outcomes, and higher concentration and frequency are beneficial in chronic CMV retinitis. An extended antiviral course could prevent relapses, but should be limited to 6 months to prevent drug resistance and side effects. In this review, we have systematically summarized the pathogenesis, clinical features, diagnostic and therapeutic aspects, and immunological mechanisms of CMV AU with the goal of providing a theoretical foundation for early clinical diagnosis and treatment.
对于免疫功能正常人群中与巨细胞病毒（CMV）感染相关的最常见眼部疾病前葡萄膜炎（AU），人们知之甚少。CMV AU 在亚洲非常普遍，男性发病率更高。临床上，它主要表现为前房炎症和眼内压（IOP）升高。急性 CMV AU 可能类似于复发性高血压虹膜炎的 Posner-Schlossman 综合征，而慢性 CMV AU 可能类似于 Fuchs 葡萄膜炎，因为其 IOP 升高。如果不及时治疗，可能会进展为青光眼；因此，早期诊断对预后至关重要。对临床特征和房水分析的了解有助于准确诊断；因此，我们对这些方面进行了比较和总结。早期抗病毒治疗可降低青光眼手术的风险，且药物疗效因药物输送方式而异。口服缬更昔洛韦和局部更昔洛韦都可以产生良好的临床效果，在慢性 CMV 视网膜炎中，更高的浓度和更频繁的给药频率更有益。延长抗病毒疗程可能有助于预防复发，但应限制在 6 个月内，以防止耐药性和副作用的发生。在这篇综述中，我们系统地总结了 CMV AU 的发病机制、临床特征、诊断和治疗方面以及免疫学机制，旨在为早期临床诊断和治疗提供理论基础。
