Association of varicella-zoster virus (VZV) load in the aqueous humor with clinical manifestations of anterior uveitis in herpes zoster ophthalmicus and zoster sine herpete

¹ Tokyo Medical and Dental University, Japan
² Miyata Hospital, Japan

^* To whom correspondence should be addressed. E-mail: sunaoph{at}tmd.ac.jp.

Accepted 4 August 2007

	Abstract

Aim: To investigative whether clinical manifestations of anterior uveitis is associated with the viral load of varicella-zoster virus (VZV) in the aqueous humor in patients with herpes zoster ophthalmicus (HZO) and zoster sine herpete (ZSH).

Methods: After informed consent was given, an aliquot of aqueous humor was collected from patients with VZV anterior uveitis (n=8). Using the aqueous humor, genomic DNAs of the human herpes viruses were measured through the use of two polymerase chain reaction (PCR) assays: (1) a qualitative multiplex PCR and (2) a quantitative real-time PCR.

Results: All patients had unilateral acute anterior uveitis with high intraocular pressure, mutton fat keratic precipitates with some pigmentation, and trabecular meshwork pigmentation. Multiplex PCR demonstrated VZV genomic DNA in all of the samples, but not in other human herpes virus samples (HSV-1, HSV-2, EBV, CMV, HHV-6, HHV-7, and HHV-8). Real-time PCR revealed a high copy number of VZV DNA in the aqueous humor. During the time after the initial onset of the anterior uveitis, iris atrophy and a distorted pupil with paralytic mydriasis developed in the patients. The intensity of the iris atrophy and pupil distortion, but not the ocular hypertension, was correlated with the viral load of VZV in the aqueous humor.

Conclusion: Viral load of VZV in the aqueous humor was well correlated with the tissue damage of the iris (iris atrophy and pupil distortion) in patients with HZO and ZSH.

Keywords: ocular fluid, polymerase chain reaction, uveitis, varicella-zoster virus, viral load

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