Elsevier

Japanese Journal of Ophthalmology

Volume 46, Issue 1, January–February 2002, Pages 70-73
Japanese Journal of Ophthalmology

Clinical investigation
Varicella-Zoster Viral Antigen Identified in Iridocyclitis Patient

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Abstract

Background: The varicella-zoster virus (VZV) antigen has not been identified immunohistologically in iridocyclitis due to VZV.

Case: A 65-year-old woman diagnosed with iridocyclitis and secondary glaucoma underwent trabeculectomy. Samples of aqueous humor and juxtacanalicular and iris tissue were obtained for immunohistological and polymerase chain reaction (PCR) study.

Observations: Slit-lamp microscopy revealed ciliary injection, corneal epithelial edema, mutton fat precipitates, flare, cells, and progressive iris atrophy in the right eye. Subsequently, scant eruptions on her right upper eyelid appeared and disappeared within a week. Although a diagnostic increase in the complement fixation antibody titer to VZV was not observed, we started medical treatment for VZV, on suspicion of iridocyclitis due to VZV. Despite medical treatment, the ratio of peripheral anterior synechia was greater than 60% and iris atrophy progressed in parallel. The intraocular pressure in the right eye remained above 30 mm Hg at 6 months after the first visit, so trabeculectomy was performed. VZV-specific DNA was detected in the aqueous humor by the PCR study. Immunohistological examination demonstrated numerous VZV antigen-positive cells in the iris stroma, in particular, vascular endothelial cells.

Conclusion: To our knowledge, this is the first report of the detection of VZV antigen in the iris of an iridocyclitis patient.

Introduction

Varicella-zoster virus (VZV) is known as an etiologic agent of iridocyclitis characterized by iris atrophy, mutton fat keratic precipitates, and secondary glaucoma. Zoster ophthalmicus without skin eruption is defined as zoster sine herpete.1, 2

Recent reports documented the usefulness of polymerase chain reaction (PCR) study in the diagnosis of zoster sine herpete.2, 3 However, it has not been reported that VZV antigen was identified immunohistologically in iridocyclitis due to VZV. We present the first report of detection of VZV antigen in the iris of an iridocyclitis patient.

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Case Report

Iridocyclitis and secondary glaucoma of the right eye were diagnosed in a 65-year-old woman visiting our hospital in June 1998. At initial examination, best-corrected visual acuity was 0.3 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 33 mm Hg in the right eye and 14 mm Hg in the left eye. Slit-lamp microscopy revealed ciliary injection, corneal epithelial edema, mutton fat keratic precipitates, flare, and cells in the anterior chamber in the right eye. The left eye

Discussion

Herpes zoster ophthalmicus is usually accompanied by a typical rash, but cases of ocular zoster with no skin eruption, ie, zoster sine herpete, have been reported.1, 2, 3, 4, 5 Cases of herpes simplex accompanying zosteriform eruptions are known as zosteriform simplex.4, 5 It is important to distinguish between herpes zoster and herpes simplex to aid in the choice of appropriate medical therapy. In this case, the vesicles that clinically simulated those caused by herpes simplex virus

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