Comparison of Clinical Characteristics between Patients with Cytomegalovirus Positive and Negative Hypertensive Uveitis

Jin-Ho Kim; Ji-Young Lee; Jin-A Choi

doi:10.3341/jkos.2020.61.3.258

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Kim, Lee, and Choi: Comparison of Clinical Characteristics between Patients with Cytomegalovirus Positive and Negative Hypertensive Uveitis

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(3): 258-266.

Published online: 17 March 2020

DOI: https://doi.org/10.3341/jkos.2020.61.3.258

Comparison of Clinical Characteristics between Patients with Cytomegalovirus Positive and Negative Hypertensive Uveitis

Jin-Ho Kim, MD, Ji-Young Lee, MD, Jin-A Choi, MD, PhD

Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea.

Address reprint requests to Jin-A Choi, MD, PhD. Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: 82-31-259-7343, Fax: 82-31-251-6225, jinah616@hanmail.net

Received 30 May 2019 Revised 7 August 2019 Accepted 21 February 2020

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

To compare the clinical characteristics of hypertensive uveitis patients, with and without cytomegalovirus (CMV) infection.

Methods

CMV polymerase chain reaction (PCR) was performed on the aqueous humor of 61 patients with hypertensive uveitis. Patients were divided into CMV positive and negative groups. Sex, age, age at first attack and at first diagnosis, duration of attack, number of attacks, interval between attacks, and surgical history were investigated, and the visual acuity, intraocular pressure (IOP), and corneal endothelial cell density were measured. Blood tests were conducted to determine the inflammation index, antibody titers of CMV, and herpes simplex virus, with toxoplasma and toxocariasis evaluations. With these results, the differences between the two groups were confirmed.

Results

Compared with the CMV negative group, the CMV positive group showed a significantly higher trough IOP (p = 0.007) and a greater difference in corneal endothelial cell counts of the affected eye and the fellow eye (p = 0.048). The CMV positive group exhibited iris degeneration (73.3%), whereas the CMV negative group showed lesions in 47.8% (p = 0.085). No statistically significant differences between the two groups were evident in terms of leukocyte count, inflammation index, antibody titers to CMV, HSV, toxoplasma, or toxocariasis.

Conclusions

CMV anterior uveitis was characterized by high IOP and corneal endothelial cell loss in the affected eyes. The CMV positive group had more corneal lesions and iris degeneration than the CMV negative group; however, the two groups showed no significant serological differences. When the clinical features of hypertensive uveitis are present, a routine corneal endothelium test and CMV PCR should be performed periodically, to initiate antiviral agent treatments along with IOP and inflammation controls.

Keywords: Cytomegalovirus, Ocular hypertension, Uveitis, Uveitic glaucoma

Figures and Tables

Figure 1

Peak and trough intraocular pressure (IOP) of cytomegalovirus (CMV)-positive and CMV-negative hypertensive uveitis. In the CMV polymerase chain reaction (PCR) positive patients, the peak IOP during the duration of the disease was found to be lower than that of the negative patients, but no statistically significant difference was observed (p = 0.199). However, the trough IOP during the duration of the disease was statistically significantly higher in the CMV PCR-positive patients than in the negative patients (p = 0.007). ^*Student's t-test; ^†Mann-Whitney's U-test.

Figure 2

Baseline and intereye differences of corneal endothelial cell density of cytomegalovirus (CMV)-positive and CMV-negative hypertensive uveitis patients. A lower corneal endothelial cell density was found in the CMV polymerase chain reaction positive patients, but no statistically significant difference was noted (p = 0.244, student's t-test). However, we also examined the corneal endothelial cell density in the opposite eye to determine the difference in binocularity, and the results showed a significant difference between CMV-positive and negative groups (p = 0.048, Mann-Whitney's U-test). ECD = endothelial cell count.

Figure 3

Different corneal manifestations of cytomegalovirus (CMV) positive hypertensive anterior uveitis patients. A 25-year-old female patient with CMV-positive anterior uveitis showed a coin-like lesion (A) and a 55-year-old male patient showed ring-like opacity (B). In addition, a 27-year-old male patient showed a simple keratic precipitate (C) and a 72-year-old male patient showed multiple keratitic precipitate with iris pigmentation (D).

Figure 4

Iris changes associated with cytomegalovirus positive hypertensive anterior uveitis. When compared to the normal opposite eye (A), the iris atrophy was observed within the affected left eye (B) of a 25-year-old female patient. A 60-year-old male patient showed a spongy-like change of inferior iris stroma of the affected eye (D), compared to the normal opposite eye (C).

Figure 5

Serial changes of a 55-year-old male patient. At baseline examination, superior ring-like opacity of the cornea was shown (A) and after 2 months, aggravation of ring like opacity was observed (B). Round stromal opacity at the center of the ring-like opacity appeared 5 months later (C). After 7 months, ring like opacity was improved (D).

Table 1

Characteristics of CMV positive and CMV negative hypertensive uveitis

The medical records and the ophthalmic test results were able to compare the overall characteristics between patient groups with CMV positive and CMV negative hypertensive uveitis. Values are presented as mean ± standard deviation or number (%).

CMV = cytomegalovirus; M:F = male:female; BCVA = best-corrected visual acuity; RNFL = retinal nerve fiber layer; CCT = central corneal thickness.

^*Student's t-test; ^†chi-square test; ^‡Mann-Whitney's U-test.

Table 2

Patients list of CMV positive hypertensive anterior uveitis

Clinical features and progress of the enrolled CMV positive hypertensive anterior uveitis patients were summarized.

CMV = cytomegalovirus; BCVA = best-corrected visual acuity; F/U = follow-up; IOP = intraocular pressure; PCR = polymerase chain reaction; ECD = endothelial cell count; M = male; PO = per os (orally); DM = diabetes mellitus; TB = tuberculosis; F = female; KP = keratic precipitate; HTN = hytertension.

Table 3

Immunologic status of CMV positive and CMV negative hypertensive uveitis

There was no statistically significant difference in serologic tests between patient groups with CMV positive and CMV negative hypertensive uveitis. Values are presented as mean ± standard deviation number (%).

CMV = cytomegalovirus; WBC = white blood cell; ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; RA = rheumatoid factor; IgM = immunoglobulin M; IgG = immunoglobulin G; Ab = antibody.

^*Student's t-test; ^†Mann-Whitney's U-test.

Notes

The authors wish to acknowledge the financial support of the a National Research Foundation of Korea funded by the Korean government (No. NRF-2019R1F1A1043806).

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