Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China.
Departments of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Indian J Ophthalmol. 2023 Dec 1;71(12):3684-3689. doi: 10.4103/IJO.IJO_2937_22. Epub 2023 Nov 20.
To examine the clinical outcomes in chronic or recurrent anterior uveitis in the presence or absence of cytomegalovirus (CMV) and investigate the predictive factors for uveitic activity and recurrence.
Polymerase chain reaction (PCR) was performed in a prospective cohort of immunocompetent adults with recurrent or chronic anterior uveitis to detect CMV in aqueous humor. The clinical outcomes were compared between eyes with and without CMV DNA. Logistic regression was performed to evaluate associations between iris depigmentation, CMV-PCR status, uveitic activity, and recurrence.
Thirty-eight eyes of 38 subjects with a mean age of 61.1 ± 11.2 years old were analyzed. Fifteen eyes were positive for CMV. More eyes with CMV developed recurrences and remained actively inflamed at 6, 12, and 24 weeks though the differences were insignificant. The presence of iris depigmentation was predictive of a greater odd of uveitic recurrences by 12 and 24 weeks (Odds ratio (OR) = 9.17 and 5.72, P = 0.007 and 0.034 respectively), whereas positive CMV-PCR predicts a greater odd of uveitic activity at postoperative 12 and 24 weeks (OR = 13.08, 34.30; P = 0.027, 0.007).
Eye with and without detectable CMV behaved similarly in their clinical course. Our findings suggested that iris depigmentation was predictive of more frequent uveitic recurrence, regardless of the PCR status, whereas the presence of CMV in aqueous humor was associated with persistent uveitic activity. Iris changes may be present during the earlier phase of the disease and precede the detection of virus from the aqueous humor at a later stage of CMV infection.
探讨巨细胞病毒（CMV）存在或不存在时慢性或复发性前葡萄膜炎的临床结果，并研究葡萄膜炎活动和复发的预测因素。
对复发性或慢性前葡萄膜炎的免疫功能正常的成年人进行前瞻性队列聚合酶链反应（PCR），以检测房水中的 CMV。比较 CMV DNA 阳性和阴性眼的临床结果。Logistic 回归分析评估虹膜色素脱失、CMV-PCR 状态、葡萄膜炎活动度和复发之间的相关性。
38 例（38 只眼）年龄 61.1±11.2 岁的患者纳入研究。15 只眼 CMV 阳性。尽管差异无统计学意义，但更多的 CMV 阳性眼在 6、12 和 24 周时出现复发且持续炎症活跃。虹膜色素脱失与 12 和 24 周时葡萄膜炎复发的可能性更大相关（优势比（OR）分别为 9.17 和 5.72，P = 0.007 和 0.034），而 CMV-PCR 阳性预测术后 12 和 24 周葡萄膜炎活动的可能性更大（OR = 13.08、34.30；P = 0.027、0.007）。
可检测到 CMV 的眼和未检测到 CMV 的眼在其临床病程中表现相似。我们的研究结果表明，无论 PCR 状态如何，虹膜色素脱失与更频繁的葡萄膜炎复发相关，而房水中存在 CMV 与持续的葡萄膜炎活动相关。虹膜变化可能出现在疾病的早期阶段，并在 CMV 感染的后期阶段从房水中检测到病毒之前出现。
