Tranos Paris, Markomichelakis Nikos, Koronis Spyridon, Sidiropoulos Georgios, Tranou Marianna, Rasoglou Achilleas, Stavrakas Panagiotis
Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece.
Ocular Inflammation Institute of Athens, Athens, Greece.
Ocul Immunol Inflamm. 2024 Nov;32(9):2138-2143. doi: 10.1080/09273948.2024.2329315. Epub 2024 Apr 15.
To describe the spectrum of clinical features of cytomegalovirus-related anterior uveitis (CMV-AU) along with potential comorbidities, to calculate complication rates, and to determine risk factors and biomarkers affecting prognosis in a cohort of a Southern European Mediterranean population.
It is a retrospective, multicenter case series of consecutive patients with persisting hypertensive AU, unresponsive to topical steroids therapy, and CMV-positive essays from two uveitis referral centers were collected and analyzed.
Fifty-seven eyes of 53 patients with polymerase chain reaction-verified CMV-AU over a period of 8 years were included with a mean age of 48 ± 18. Four presentation patterns were identified: 26.3% as Posner-Schlossman-like, 31.6% as chronic AU, 19.3% as presumed herpetic uveitis, 12.3% as Fuchs uveitis syndrome-like, and 10.5% without specific initial classification. About 15.8% received oral valganciclovir, 22.8% received topical valganciclovir, and 61.4% received both, for a mean duration of treatment of 44 months. AU recurrences were observed in 23 eyes with a mean of 1.5 (±1.5) recurrences per year. The only finding significantly associated with recurrence was the presence of posterior synechiae (PS) ( = 0.034). Fewer keratic precipitates (KPs) were indicative for the need of longer treatment, and endotheliitis was strongly associated with the need for filtration surgery.
In this immunocompetent southern European population, four distinct clinical presentation patterns were further confirmed, and possible biomarkers such as PS, KPs, and endotheliitis were newly reported to influence treatment outcomes. Large-scale studies could provide a more effective customized treatment protocol.
描述巨细胞病毒相关性前葡萄膜炎（CMV-AU）的临床特征谱及其潜在合并症，计算并发症发生率，并确定影响南欧地中海人群队列预后的危险因素和生物标志物。
这是一项回顾性、多中心病例系列研究，收集并分析了来自两个葡萄膜炎转诊中心的连续患者，这些患者患有持续性高血压性前葡萄膜炎，对局部类固醇治疗无反应，且巨细胞病毒检测呈阳性。
在8年期间纳入了53例经聚合酶链反应验证为CMV-AU的患者的57只眼，平均年龄为48±18岁。确定了四种表现模式：26.3%为类似波斯纳-施洛斯曼综合征，31.6%为慢性前葡萄膜炎，19.3%为疑似疱疹性葡萄膜炎，12.3%为类似富克斯葡萄膜炎综合征，10.5%无特定初始分类。约15.8%接受口服缬更昔洛韦，22.8%接受局部缬更昔洛韦，61.4%两者均接受，平均治疗持续时间为44个月。23只眼观察到前葡萄膜炎复发，平均每年复发1.5（±1.5）次。与复发显著相关的唯一发现是存在后粘连（PS）（P = 0.034）。角膜后沉着物（KP）较少表明需要更长时间的治疗，且内皮炎症与滤过手术的需求密切相关。
在这个具有免疫能力的南欧人群中，进一步证实了四种不同的临床表现模式，并且新报道了诸如PS、KP和内皮炎症等可能的生物标志物会影响治疗结果。大规模研究可以提供更有效的定制治疗方案。
