Polymerase chain reaction—based assays of vitreous samples for the diagnosis of viral retinitis: Use in diagnostic dilemmas

doi:10.1016/S0161-6420(98)71127-2

Ophthalmology

Volume 105, Issue 1, January 1998, Pages 37-45

https://doi.org/10.1016/S0161-6420(98)71127-2 Get rights and content

Objective:

This study aimed to review the authors' results using polymerase chain reaction (PCR)-based assays for the diagnosis of viral retinitis.

Design:

The study design was a retrospective case series.

Participants:

Thirty-seven patients (38 eyes) with active retinitis from whom vitreous biopsy specimens were received in the authors' laboratory for diagnostic evaluation.

Intervention:

Vitreous biopsy specimens were evaluated with previously described PCR-based assays for cytomegalovirus (CMV), varicella zoster virus (VZV), and herpes simplex virus (HSV) DNA; clinical histories were reviewed.

Main Outcome Measures:

Laboratory findings and clinical course were measured.

Results:

The results of the authors' assays were consistent with the long-term clinical course of each patient. Cytomegalovirus, VZV, or HSV DNA was detected in the vitreous from 24 patients. Cytomegalovirus DNA was detected in vitreous biopsy specimens from 10 patients (11 eyes). Nine patients (ten eyes) with acquired immune deficiency syndrome ultimately were diagnosed with CMV retinitis as they were followed clinically over time. Varicella zoster virus DNA was detected in vitreous biopsy specimens from eight patients; seven adult patients were ultimately diagnosed with acute retinal necrosis or progressive outer retinal necrosis. Herpes simplex virus DNA was detected in vitreous biopsy specimens from six patients; five patients had previous or subsequent herpes encephalitis. No viral DNA was detected in the vitreous from 13 patients; all were ultimately diagnosed with toxoplasmosis, syphilis, Behcet disease, fungal endophthalmitis, or idiopathic inflammation.

Conclusions:

These data further support the use of PCR-based assays of vitreous specimens in the diagnostic evaluation of patients with infectious retinitis.

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Citation Excerpt :
Other ancillary investigations, including laboratory tests for viral serology and imaging, can be used to confirm the diagnosis.270 Polymerase chain reaction (PCR) analyses of intraocular fluid samples are an effective aid for diagnosis50,70,135,229,239,267 and subsequent management84,204 of viral posterior uveitis caused by HSV, VZV, and CMV. The tetraplex PCR analysis of intraocular fluids for HSV, VZV, and CMV is effective in confirming the etiological pathogen involved in 59–100% of cases,28,84,204,211 with PCR having a sensitivity of 80.9%–84.0% and a specificity of 97.4%–100.0%.50,84,135,211
The causes of posterior uveitis can be divided into infectious, autoimmune, or masquerade syndromes. Viral infections, a significant cause of sight-threatening ocular diseases in the posterior segment, include human herpesviruses, measles, rubella, and arboviruses such as dengue, West Nile, and chikungunya virus. Viral posterior uveitis may occur as an isolated ocular disease in congenital or acquired infections or as part of a systemic viral illness. Many viruses remain latent in the infected host with a risk of reactivation that depends on various factors, including virulence and host immunity, age, and comorbidities. Although some viral illnesses are self-limiting and have a good visual prognosis, others, such as cytomegalovirus retinitis or acute retinal necrosis, may result in serious complications and profound vision loss. Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. We review the clinical features, diagnostic tools, treatment regimens, and long-term outcomes for each of these viral posterior uveitides.

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: Presented as a paper at the American Academy of Ophthalmology Annual Meeting, Chicago, Illinois, October 1996.

: Supported by a Research to Prevent Blindness Lew Wasserman Merit Award (TPM) and a grant from the University Wide AIDS Research Program (Oakland, CA).

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Polymerase chain reaction—based assays of vitreous samples for the diagnosis of viral retinitis: Use in diagnostic dilemmas

Objective:

Design:

Participants:

Intervention:

Main Outcome Measures:

Results:

Conclusions:

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