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Diagnosis and management of cytomegalovirus anterior uveitis/endothelitis in immunocompetent patients in 2 European referral centers
Author(s) -
Antoun J.,
Caspers L.,
GrootMijnes J.,
Motulsky E.,
Damvan Loon N.H.T.,
Makhoul D.,
Willermain F.,
Judice Relvas L.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0386
Subject(s) - medicine , ganciclovir , uveitis , retrospective cohort study , anterior uveitis , referral , young adult , gastroenterology , surgery , human cytomegalovirus , ophthalmology , virus , immunology , family medicine
Purpose To evaluate the methods leading to the diagnosis of CMV anterior uveitis (AU) and/or endotheliitis from 2 uveitis tertiary referrals centers and to assess the outcome after topical ganciclovir treatment. Methods Retrospective study of patients with a clinical and biological diagnosis of CMV AU/endothelitis demonstrated by a positive polymerase chain reaction (PCR) and/or Goldmann‐Witmer coefficient (GWc). The Belgian patients were treated with topical ganciclovir once the biological diagnosis was confirmed. The number of recurrences was evaluated in the pre‐ and post‐treatment period. Results We report a series of 21 patients (15 from Brussels and 6 from Utrecht) presenting clinical characteristics of CMV AU and/or endothelitis with a positive PCR and/or GWc for CMV. PCR was positive in 15/21 (71.4%) patients, while GWc was positive in 8/9 (88.9%), including 6 patients initially tested for PCR and GWc and 3 secondary tested for GWc when the PCR was negative. 2/9 patients (22.2%) were GWc+/PCR+, 6/9 patients (66.7%) GWc+/PCR‐ and 1/9 patient was GWc‐/PCR+ (11.1%). Aqueous tap was repeated in 9 of the 15 Belgian patients (60%) (2 times in 6 cases, 3 times in 3 cases) to get the biological confirmation of CMV AU/endothelitis. Mean follow up duration was respectively 19.2 ± 23.8 and 46.7 ± 29.7 months in the pre‐ and post‐treatment period. Patients had a significantly lower number of recurrences/year post‐treatment (0.76 ± 0.57) than in the pre‐treatment period (3.76 ± 2.44) (p = 0.001). Conclusions Repeated aqueous taps in order to perform PCR and GWc were found to be helpful to confirm biologically the clinical diagnosis of CMV AU/ endothelitis. Our results also suggest that patients with topical ganciclovir have a decreased frequency of CMV‐AU/endotheliitis recurrence and keep a relatively good vision over time.