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Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis
  1. I de Schryver1,2,
  2. F Rozenberg3,
  3. N Cassoux1,
  4. S Michelson4,
  5. P Kestelyn2,
  6. P LeHoang1,
  7. J L Davis5,
  8. B Bodaghi1
  1. 1Department of Ophthalmology, University of Paris VI, Pitié-Salpêtrière Hospital, 47-83 bd de l’Hôpital, 75651 Paris, France
  2. 2Department of Ophthalmology, Ghent, Belgium
  3. 3Laboratory of Virology, Hôpital Saint Vincent de Paul, Paris, France
  4. 4Laboratory of Viral Immunology, Pasteur Institute, Paris, France
  5. 5University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL 33136, USA
  1. Correspondence to: Bahram Bodaghi MD PhD, Department of Ophthalmology, University of Paris VI, Pitié-Salpêtrière Hospital, 47-83 bd de l’Hôpital, 75651 Paris, France; bahram.bodaghi{at}psl.ap-hop-paris.fr

Abstract

Aim: To describe the diagnostic and therapeutic management of cytomegalovirus (CMV) anterior uveitis unassociated with retinal necrosis in immunocompetent patients.

Methods: Patients referred between 2001 and 2003 for management of unilateral, chronic, recurrent uveitis associated with secondary glaucoma underwent extensive investigation including laboratory tests for herpes virus infections. Specific antiviral treatment was initiated in all cases and the level of ocular inflammation was evaluated during the follow up.

Results: Five patients, three men and two women, were included. Median age was 50 years old (range 30–80 years). Anterior unilateral uveitis without iris atrophy was observed in all cases. Uveitis was chronic in three cases and recurrent in two cases. Glaucoma was observed in all patients with a median intraocular pressure of 30 mm Hg (range 22–43 mm Hg). Five patients responded initially to specific anti-CMV therapy. Even though glaucoma surgery was necessary in two cases, both ocular inflammation and glaucoma were controlled in all cases. Relapses occurred in three cases after cessation of therapy, requiring prolonged maintenance therapy with valganciclovir.

Conclusions: CMV infection and specific antiviral therapy should be considered in all cases of relapsing or chronic iridocyclitis and secondary glaucoma. Maintenance regimens of valganciclovir may be necessary to prevent further relapses.

  • CMV, cytomegalovirus
  • EBV, Epstein-Barr virus
  • HSV, herpes simplex virus
  • IgG, immunoglobulin G
  • KP, keratic precipitates
  • PCR, polymerase chain reaction
  • PSS, Posner-Schlossman syndrome
  • PVU, presumed viral uveitis
  • VZV, varicella zoster virus
  • anterior chamber paracentesis
  • cytomegalovirus
  • uveitis
  • ganciclovir
  • glaucoma
  • polymerase chain reaction
  • Posner-Schlossman syndrome
  • CMV, cytomegalovirus
  • EBV, Epstein-Barr virus
  • HSV, herpes simplex virus
  • IgG, immunoglobulin G
  • KP, keratic precipitates
  • PCR, polymerase chain reaction
  • PSS, Posner-Schlossman syndrome
  • PVU, presumed viral uveitis
  • VZV, varicella zoster virus
  • anterior chamber paracentesis
  • cytomegalovirus
  • uveitis
  • ganciclovir
  • glaucoma
  • polymerase chain reaction
  • Posner-Schlossman syndrome

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