Aqueous tap and rapid diagnosis of cytomegalovirus anterior uveitis: the Reggio Emilia experience

  • L. De Simone
  • L. Belloni
  • R. Aldigeri
  • A. Zerbini
  • V. Mastrofilippo
  • A. Sangiovanni
  • M. Parmeggiani
  • L. Fontana
  • Luca CiminoEmail author
Inflammatory Disorders



The diagnosis of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients requires confirmation by polymerase chain reaction (PCR) analysis and/or intraocular antibody index (AI) assay. In this study, we analyzed the different contributions of PCR and AI to CMV diagnosis by performing one single aqueous tap.


A retrospective chart review was conducted of HIV-negative patients attending the Ocular Immunology Unit of Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, Italy, from March 2015 to April 2018 with a diagnosis of hypertensive anterior granulomatous uveitis compatible with suspected CMV etiology. Diagnosis was confirmed by real-time PCR (RT-PCR) and intraocular antibody production against CMV on aqueous humor samples. Clinical features were compared to antibody titer and diagnostic delay.


Twenty-three patients with suspected CMV uveitis (13 males, 10 females, mean age 48 ± 16 years) were included in the analysis. AI was positive in 20/23 (87%) samples, and PCR tested positive in 9/23 (39%). By combining both tests, the sensitivity was 100%. Median diagnostic delay was 29 months (IQR 9–107). Diagnostic delay and antibody titer were significantly associated with glaucoma (r = 0.714, p < 0.0001; r = 0.476, p = 0.02, respectively).


Our data suggest that to improve the diagnostic accuracy of CMV anterior uveitis, PCR and AI are both useful and complimentary. In our series, AI was the most sensitive diagnostic tool. One single aqueous tap is sufficient to achieve 100% sensitivity in CMV diagnosis. Early diagnosis is necessary to prevent the development of glaucoma.


Viral anterior uveitis Cytomegalovirus Antibody index Goldmann-Witmer coefficient PCR Glaucoma 



We thank Catia Ferrari, Antonella Bartoli, Morena Menozzi, and Ledi Bigi for the collection and management of biological specimens.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Ocular Immunology UnitAzienda USL IRCCSReggio EmiliaItaly
  2. 2.Ophthalmology DepartmentCampus Bio-Medico UniversityRomeItaly
  3. 3.Clinical Immunology, Allergy, and Advanced Biotechnologies Unit, Diagnostic Imaging and Laboratory Medicine DepartmentAzienda USL IRCCSReggio EmiliaItaly
  4. 4.Medicine and Surgery DepartmentUniversity of ParmaParmaItaly
  5. 5.Ophthalmology Department, Azienda USL IRCCSReggio EmiliaItaly

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