Kotingová Veronika, Fichtl Marek, Brichová Michaela, Svozílková Petra, Klímová Aneta, Rezková Lucie, Škrlová Eva, Heissigerová Jarmila
Cesk Slov Oftalmol. 2025;81(2):61-67. doi: 10.31348/2024/40.
The aim of the article is to summarize observations on cytomegalovirus (CMV) anterior uveitis, and in short case reports present cases of patients treated at our Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague.
Retrospective analysis of patients at the Centre for diagnosis and treatment of uveitis from 2003 to 2024. Presentation of our experiences with CMV anterior uveitis confirmed by polymerase chain reaction (PCR) in aqueous humor in case reports.
From a cohort of 3844 patients with uveitis, 3 patients were diagnosed with CMV anterior uveitis, confirmed by PCR in the aqueous humor. The clinical presentation was as acute recurrent hypertensive anterior uveitis in all patients, with a switch to chronic form with elevated intraocular pressure (IOP). Despite local anti-inflammatory and antiglaucomatous therapy, there was high recurrence of uveitis with decompensation of IOP when the medication was reduced. Patients underwent antiglaucoma surgery because of persistent high IOP despite maximal local antiglaucomatous therapy. An anterior chamber tap was taken for PCR analysis, with a CMV-positive result. After the initiation of antiviral therapy with local ganciclovir, patients manifested compensated IOP and a pronounced reduction of recurrences of uveitis and progression of glaucoma.
CMV anterior uveitis is a rare pathology in our geographic region, but it is important to consider this etiology in cases of recurrent anterior hypertensive uveitis with a low response to local anti-inflammatory medication. Timely verification of the etiological agent with prompt diagnosis and treatment is essential in order to achieve a favorable prognosis. Long-term, low maintenance doses of antiviral therapy with local ganciclovir for several months reduce relapses of uveitis and lead to compensation of IOP.
本文旨在总结对巨细胞病毒（CMV）前葡萄膜炎的观察结果，并在简短的病例报告中呈现布拉格查理大学医学院第一附属医院眼科治疗的患者病例。
对2003年至2024年葡萄膜炎诊断和治疗中心的患者进行回顾性分析。在病例报告中介绍我们在房水中通过聚合酶链反应（PCR）确诊的CMV前葡萄膜炎的经验。
在3844例葡萄膜炎患者队列中，3例被诊断为CMV前葡萄膜炎，房水PCR确诊。所有患者的临床表现均为急性复发性高血压性前葡萄膜炎，转为慢性形式时眼压（IOP）升高。尽管进行了局部抗炎和抗青光眼治疗，但当药物减少时，葡萄膜炎复发率高且IOP失代偿。尽管进行了最大程度的局部抗青光眼治疗，但由于IOP持续升高，患者接受了抗青光眼手术。抽取前房液进行PCR分析，结果CMV呈阳性。在用局部更昔洛韦开始抗病毒治疗后，患者IOP得到代偿，葡萄膜炎复发和青光眼进展明显减少。
CMV前葡萄膜炎在我们所在地理区域是一种罕见的病理情况，但在对局部抗炎药物反应低的复发性前高血压性葡萄膜炎病例中考虑这种病因很重要。及时验证病原体并迅速诊断和治疗对于获得良好预后至关重要。长期使用低维持剂量的局部更昔洛韦进行抗病毒治疗数月可减少葡萄膜炎复发并导致IOP代偿。
