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Cho, Lee, Kim, Kim, and Kim: Clinical Manifestations and Outcomes of Varicella-zoster Virus Endotheliitis
Original Article

Journal of the Korean Ophthalmological Society 2019; 60(12): 1162-1168.

Published online: 17 December 2019

DOI: https://doi.org/10.3341/jkos.2019.60.12.1162

Clinical Manifestations and Outcomes of Varicella-zoster Virus Endotheliitis

Yong Wun Cho, MD1, Dong Woo Lee, MD1, Gyu Nam Kim, MD1, 2, Hyun-A Kim, MD1, 2, Seong-Jae Kim, MD1, 2

1Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

2Health Science Institute, Gyeongsang National University, Jinju, Korea.

Address reprint requests to Seong-Jae Kim, MD, PhD. Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea. Tel: 82-55-750-8171, Fax: 82-55-758-4158, maya12kim@naver.com

Received 16 August 2019       Revised 19 September 2019       Accepted 6 December 2019

©2019 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the clinical manifestations of varicella-zoster virus (VZV)-induced endotheliitis and treatment outcomes.

Methods

We retrospectively reviewed the medical records of patients exhibiting clinical manifestations of endotheliitis diagnosed as VZV endotheliitis via polymerase chain reaction (PCR) of anterior chamber puncture fluid from January 2013 to December 2018. Their clinical characteristics, treatments, and outcomes were analyzed.

Results

Seven eyes of seven patients were diagnosed as VZV-affected via PCR of the aqueous humor. Mean patient age was 70.4 ± 10.4 years and the average follow-up time 24.7 ± 3.8 months. All eyes exhibited mild anterior chamber inflammation (trace to 1+). Four eyes were disciform in shape and three exhibited diffuse endotheliitis. Six patients evidenced intraocular pressures >21 mmHg. All patients were treated with oral antiviral agents; they were cured and no recurrence was noted. The mean best-corrected visual acuity (logMAR) increased significantly from 0.73 ± 0.19 to 0.09 ± 0.07 and the mean ocular pressure decreased significantly from 26.1 ± 7.3 to 13.2 ± 2.1 mmHg.

Conclusions

VZV endotheliitis may present as mild inflammation of the anterior chamber with a disciform eye or diffuse corneal edema. Diagnosis is aided by VZV-specific PCR of anterior chamber fluid; oral antiviral agents are useful. Be diagnosed with PCR of anterior chamber, and be treated with oral antiviral agents.

Keywords: Acyclovir, Endotheliitis, Varicella-zoster virus

Figures and Tables

Figure 1

Clinical photographs of patients 5. Slit lamp photograph showed corneal edema and multiple keratic precipitates at initial visit (A). Slit lamp photograph showed decreased corneal edema and keratic precipitates after the antiviral treatment (B). Corneal central thickness decreased from 632 µm to 558 µm after the treatment (C, D). Decreased number, polymegathism, and hypo-reflectivity of corneal endothelial cells were observed in specular microscopy (E). Multiplex polymerase chain reaction showed positive with VZV in aqueous humor (F). CD = cell density; CMV = cytomegalovirus; HHV6 = human herpes virus 6; EBV = Epstein-Barr virus; VZV = Varicella-zoster virus; HSV1, 2 = herpetic simplex virus 1, 2; IC = internal control; PC = positive control; NC = negative control.

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Figure 2

Initial slit lamp photographs of patients 1 to 4. Slit lamp photograph showed diffuse corneal edema and keratic precipitates in the eye of patient 1 with paralytic mydriasis (A, B). Disciform corneal edema and mutton-fat keratic precipitates were observed in the eye of patient 2 with paralytic mydriasis (C, D). Iris atrophy and keratic precipitates were observed in the eye of patient 3 (E, F). Disciform corneal edema and pseudodendritic lesion, keratic precipitates were observed in the eye of patient 4 (G, H).

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Figure 3

Initial slit lamp photographs of patients 5 to 7. Slit lamp photograph showed diffuse corneal edema and mutton-fat keratic precipitates in the eye of patient 5 (A, B). Corneal edema and keratic precipitates were observed in the eye of patient 6 (C, D). Disciform corneal edema and mutton-fat keratic precipitates were observed in the eye of patient 7 (E, F).

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Table 1

Clinical data of patients with VZV endotheliitis

jkos-60-1162-i001

VZV = varicella-zoster virus; AC = anterior chamber; KPs = keratic precipitates; M = male; F = female; SD = standard deviation.

Table 2

Changes of visual acuity and intraocular pressure

jkos-60-1162-i002

Pt. = patient; BCVA = best corrected visual acuity; IOP = intraocular pressure; ECC = endothelial cell count; CCT = central corneal thickness.

*Paired-samples t-test.

Table 3

Course of treatment in patients

jkos-60-1162-i003

Pt. = patient; N = no.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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