Presumed Fuchs Heterochromic Iridocyclitis and Posner-Schlossman Syndrome: Comparison of Cytomegalovirus-Positive and Negative Eyes

doi:10.1016/j.ajo.2008.09.001

American Journal of Ophthalmology

Volume 146, Issue 6, December 2008, Pages 883-889.e1

https://doi.org/10.1016/j.ajo.2008.09.001 Get rights and content

Purpose

To compare the characteristics of cytomegalovirus (CMV)-positive and negative eyes with presumed Posner-Schlossman syndrome (PSS) and Fuchs heterochromic iridocyclitis (FHI).

Design

Retrospective interventional case series.

Methods

One hundred and three eyes of 102 patients with presumed PSS or FHI, seen at the Singapore National Eye Centre, underwent aqueous analysis for CMV by polymerase chain reaction (PCR). Their records were reviewed for clinical features and human immunodeficiency virus (HIV) status of the CMV-positive patients. The main outcome measures were age, gender, maximum intraocular pressure, endothelial cell count, endothelial changes, PCR results, and presence of uveitic cataract and/or glaucoma.

Results

Sixty-seven eyes with presumed PSS were tapped, of which 35 (52.2%) were CMV-positive. There were 36 eyes of 35 patients with presumed FHI, of which 15 (41.7%) were CMV-positive. All the CMV-positive patients were HIV negative. Nodular endothelial lesions were seen in 18 eyes (36.0%) with CMV infection, and reticulate deposits were seen in all the presumed FHI eyes. CMV-positive and CMV-negative PSS eyes were clinically similar. Older age at diagnosis, male gender, and nodular endothelial lesions were significantly associated with CMV infection in presumed FHI eyes (age: odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0 to 1.2; P = .01; male gender: OR, 9.4; 95% CI, 1.0 to 88.6; P = .049; nodular endothelial lesions: OR, 13.9; 95% CI, 1.5 to 132.7; P = .02).

Conclusions

There are no clinically detectable differences between CMV-positive and negative presumed PSS eyes. CMV-positive presumed FHI patients are more likely to be male, older at diagnosis or have nodular endothelial lesions.

Section snippets

Methods

This was a retrospective review of all consecutive patients with presumed PSS or FHI who were seen at the uveitis clinic of the Singapore National Eye Centre (SNEC) from January 1, 2004 to December 31, 2006, who had their aqueous analyzed for viral DNA following informed consent. All eyes with hypertensive anterior uveitis that were seen in the uveitis clinic were managed according to a standard protocol where all new cases, eyes with presumed PSS presenting during an attack, and all eyes with

Results

During this period, 103 eyes of 102 patients were eligible for inclusion in the study and all consented to aqueous sampling for CMV DNA. Sixty-seven eyes had features consistent with PSS (presumed PSS) and 36 had features consistent with FHI (presumed FHI). There were another seven eyes with presumed PSS seen at this time who were quiescent and hence were not included in the study. All the presumed FHI eyes were recruited. Hence, all the eyes with presumed FHI and 90.5% of those with presumed

Discussion

In this study, we found that 35 (52.2%) of presumed PSS eyes were CMV-positive. However, there were no clinical features that enabled the clinician to differentiate between the CMV-positive and the CMV-negative eyes. This could possibly be because presumed PSS is in fact a CMV uveitis, and our positive rate may in fact be an underestimation of the true ocular CMV infection rate. Six (8.9%) of the PSS eyes were positive only on repeat taps. The initial negative results could have been

Soon-Phaik Chee graduated from the National University of Singapore and became a Fellow of the Royal College of Ophthalmologists in 1990. She did her ocular inflammation fellowship in Moorfields Eye Hospital, United Kingdom. Dr Chee is currently the Senior Consultant and Head of the Ocular Inflammation and Immnology Service at the Singapore National Eye Centre, and the Associate Professor, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore.

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Original articlePresumed Fuchs Heterochromic Iridocyclitis and Posner-Schlossman Syndrome: Comparison of Cytomegalovirus-Positive and Negative Eyes

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalomology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Possible role of cytomegalovirus infection in the etiology of the Posner-Schlossman syndrome

Int Ophthalmol

Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction

Eye

Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis

Br J Ophthalmol

Cytomegalovirus as an etiologic factor in corneal endotheliitis

Ophthalmology

Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients

Am J Ophthalmol

Validation of a diagnostic multiplex polymerase chain reaction assay for infectious posterior uveitis

Arch Ophthalmol

Optimization of quantitative detection of cytomegalovirus DNA in plasma by real-time PCR

J Clin Microbiol

Original article
Presumed Fuchs Heterochromic Iridocyclitis and Posner-Schlossman Syndrome: Comparison of Cytomegalovirus-Positive and Negative Eyes