Cytomegalovirus as a cause of hypertensive anterior uveitis in immunocompetent patients
Tóm tắt
The aims of this study are to investigate the clinical characteristics of patients with anterior hypertensive uveitis and to compare the characteristics between patients in cytomegalovirus (CMV)-positive and CMV-negative groups in their aqueous humor samples. Immunocompetent patients (n = 42) with a history of chronic and/or recurrent hypertensive anterior uveitis underwent ophthalmic examination and serological tests. Among the 42 patients with hypertensive anterior uveitis, aqueous humor sampling was performed in 21, and they were analyzed for viral deoxyribonucleic acids using the polymerase chain reaction (PCR). The average age of the 42 patients with hypertensive anterior uveitis was 57.6 years, and 29 (69.0 %) of the subjects were males. Of the patients, 22 (52.4 %) underwent glaucoma surgery, and the average corneal endothelial cell counts were 1908 cells/mm2. Among the 21 patients who underwent an aqueous sampling, 6 were positive for CMV-DNA, while 15 were negative. The frequency of glaucoma surgery was similar between groups (CMV positive vs. CMV negative, 66.0 vs. 66.0 %, P = 0.701). However, 66.7 % of the CMV-positive group underwent glaucoma tube shunt surgery, whereas 80 % of the CMV-negative group underwent trabeculectomy or received an ExPRESS glaucoma filtration device (Alcon, Fort Worth, TX) for glaucoma surgery (P = 0.095). The corneal endothelial cell counts were significantly lower in the CMV-positive group (CMV positive vs. CMV negative, 1245 ± 560 vs. 1981 ± 387 cells/mm2; P = 0.009). CMV was found to be an etiological factor in patients with hypertensive anterior uveitis in Korea. Special caution is needed for patients with CMV-induced hypertensive anterior uveitis, considering its adverse effect on the corneal endothelium.
Tài liệu tham khảo
Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH (2008) Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol 145:834–840
van Boxtel LA, van der Lelij A, van der Meer J, Los LI (2007) Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology 114:1358–1362
Jap A, Chee SP (2010) Emerging forms of viral uveitis in the developing world. Int Ophthalmol Clin 50:155–171
Jap A, Chee SP (2011) Viral anterior uveitis. Curr Opin Ophthalmol 22:483–488
Park SW, Yu HG (2013) Association of cytomegalovirus with idiopathic chronic anterior uveitis with ocular hypertension in Korean patients. Ocul Immunol Inflamm 21:192–196
Knox DL (2008) Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol 146:625, author reply 625-626
Koizumi N, Inatomi T, Suzuki T et al (2015) Clinical features and management of cytomegalovirus corneal endotheliitis: analysis of 106 cases from the Japan corneal endotheliitis study. Br J Ophthalmol 99:54–58
Kobayashi A, Yokogawa H, Higashide T, Nitta K, Sugiyama K (2012) Clinical significance of owl eye morphologic features by in vivo laser confocal microscopy in patients with cytomegalovirus corneal endotheliitis. Am J Ophthalmol 153:445–453
Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH (2007) Corneal endotheliitis associated with evidence of cytomegalovirus infection. Ophthalmology 114:798–803
Sungur GK, Hazirolan D, Yalvac IS, Ozer PA, Aslan BS, Duman S (2010) Incidence and prognosis of ocular hypertension secondary to viral uveitis. Int Ophthalmol 30:191–194
Kandori M, Miyazaki D, Yakura K, Komatsu N, Touge C, Ishikura R, Inoue Y (2013) Relationship between the number of cytomegalovirus in anterior chamber and severity of anterior segment inflammation. Jpn J Ophthalmol 57(6):497–502
Lewkowicz D, Willermain F, Relvas LJ et al (2015) Clinical outcome of hypertensive uveitis. J Ophthalmol 2015:974870
Chee SP, Jap A (2011) Immune ring formation associated with cytomegalovirus endotheliitis. Am J Ophthalmol 152:449–453, e441
Taylor-Wiedeman J, Sissons JG, Borysiewicz LK, Sinclair JH (1991) Monocytes are a major site of persistence of human cytomegalovirus in peripheral blood mononuclear cells. J Gen Virol 72:2059–2064
Smith MS, Bentz GL, Alexander JS, Yurochko AD (2004) Human cytomegalovirus induces monocyte differentiation and migration as a strategy for dissemination and persistence. J Virol 78:4444–4453
Wikby A, Johansson B, Olsson J, Löfgren S, Nilsson BO, Ferguson F (2002) Expansions of peripheral blood CD8 T-lymphocyte subpopulations and an association with cytomegalovirus seropositivity in the elderly: the Swedish NONA immune study. Exp Gerontol 37:445–453
Solana R, Tarazona R, Aiello AE et al (2012) CMV and immunosenescence: from basics to clinics. Immun Ageing 9:23
Reeves MB, MacAry PA, Lehner PJ, Sissons JG, Sinclair JH (2005) Latency, chromatin remodeling, and reactivation of human cytomegalovirus in the dendritic cells of healthy carriers. Proc Natl Acad Sci U S A 102:4140–4145
Halenius A, Hengel H (2014) Human cytomegalovirus and autoimmune disease. Biomed Res Int 2014:472978
Söderberg-Nauclér C (2008) HCMV microinfections in inflammatory diseases and cancer. J Clin Virol 41:218–223
Prösch S, Heine AK, Volk HD, Krüger DH (2001) CCAAT/enhancer-binding proteins alpha and beta negatively influence the capacity of tumor necrosis factor alpha to up-regulate the human cytomegalovirus IE1/2 enhancer/promoter by nuclear factor kappaB during monocyte differentiation. J Biol Chem 276:40712–40720
Prösch S, Staak K, Stein J et al (1995) Stimulation of the human cytomegalovirus IE enhancer/promoter in HL-60 cells by TNFalpha is mediated via induction of NF-kappaB. Virology 208:197–206
Sims JL, Chee SP (2010) Cytomegalovirus endotheliitis following fluocinolone acetonide (Retisert) implant. Eye (Lond) 24:197–198
Tugal-Tutkun I, Araz B, Cagatay A (2010) CMV retinitis after intravitreal triamcinolone acetonide injection in a patient with Behçet’s uveitis. Int Ophthalmol 30:591–593
Ufret-Vincenty RL, Singh RP, Lowder CY, Kaiser PK (2007) Cytomegalovirus retinitis after fluocinolone acetonide (Retisert) implant. Am J Ophthalmol 143:334–335
Park UC, Kim SJ, Yu HG (2011) Cytomegalovirus endotheliitis after fluocinolone acetonide (Retisert) implant in a patient with Behçet uveitis. Ocul Immunol Inflamm 19:282–283
Goyal R, Ram AR (2000) Brimonidine tartarate 0.2 % (Alphagan) associated granulomatous anterior uveitis. Eye (Lond) 14:908–910
Cates CA, Jeffrey MN (2003) Granulomatous anterior uveitis associated with 0.2 % topical brimonidine. Eye (Lond) 17:670–671
Warwar RE, Bullock JD, Ballal D (1998) Cystoid macular edema and anterior uveitis associated with latanoprost use. Experience and incidence in a retrospective review of 94 patients. Ophthalmology 105:263–268