Identification of Subtypes of Herpetic Anterior Uveitis and Characterization of Their Clinical Features and Visual Outcome in a Chinese Population.

PURPOSE

To identify the subtypes among patients clinically diagnosed as herpetic anterior uveitis (HAU) and characterize their clinical features and visual prognosis.

METHODS

Three hundred and seventeen patients were clinically diagnosed as HAU in our department. Aqueous humor (AqH) and serum were collected from 43 of 317 HAU patients during eye surgery. Pathogens were identified using droplet digital polymerase chain reaction and the Goldmann-Witmer coefficient. The AqH levels of 10 inflammatory cytokines were measured. The demographics, clinical features, treatment, and visual prognosis of the subtypes of HAU identified by AqH analysis were analysed.

RESULTS

DNA for herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV) were identified in 13,18 and 12 eyes, respectively. The AqH levels of interleukin-13, interferon-γ, and tumor necrosis factor-α were significantly higher in VZV-AU as compared with HSV-AU and CMV-AU (all P < 0.05). In general, all these three subtypes of HAU had clinical features in common, including mutton-fat keratic precipitates usually toned with pigmentation, iris atrophy, elevated intraocular pressure (IOP), and posterior synechia with pupil pulling appearance unlike that caused by other uveitis. A much higher IOP and poor visual acuity at first visit were more commonly observed in VZV-AU and CMV-AU as compared with HSV-AU (both P < 0.05). A poor visual prognosis was noted in VZV-AU as compared with HSV-AU and CMV-AU (P = 0.010).

CONCLUSIONS

Our study identified three subtypes of HAU and characterized their clinical features. VZV-AU is frequently associated with much higher IOP and a poor visual prognosis.

TRANSLATIONAL RELEVANCE

We addressed the similarity and difference regarding clinical features and visual prognosis among three subtypes of HAU and also found droplet digital polymerase chain reaction is a sensitive technique for identifying its subtypes throughout the disease course.