Aqueous tap and rapid diagnosis of cytomegalovirus anterior uveitis: the Reggio Emilia experience
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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.
KeywordsViral 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.
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 was obtained from all individual participants included in the study.
- 1.Pang C (2012) Review of cytomegalovirus anterior uveitis. In: Inflammation, chronic diseases and cancer-cell and molecular biology, immunology and clinical bases. InTech. https://doi.org/10.5772/25545
- 6.de Boer JH, Verhagen C, Bruinenberg M, Rothova A, de Jong PT, Baarsma GS, Van der Lelij A, Ooyman FM, Bollemeijer JG, Derhaag PJ, Kijlstra A (1996) Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis. Am J Ophthalmol 121(6):650–658CrossRefGoogle Scholar
- 8.Cimino L, Aldigeri R, Parmeggiani M, Belloni L, Zotti CA, Fontana L, Invernizzi A, Salvarani C, Cappuccini L (2013) Searching for viral antibodies and genome in intraocular fluids of patients with Fuchs uveitis and non-infectious uveitis. Graefes Arch Clin Exp Ophthalmol 251(6):1607–1612. https://doi.org/10.1007/s00417-013-2287-6 CrossRefGoogle Scholar
- 9.De Groot-Mijnes JD, Rothova A, Van Loon AM, Schuller M, Ten Dam-Van Loon NH, De Boer JH, Schuurman R, Weersink AJ (2006) Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis. Am J Ophthalmol 141(2):313–318. https://doi.org/10.1016/j.ajo.2005.09.017 CrossRefGoogle Scholar
- 12.Relvas LJM, Antoun J, de Groot-Mijnes JDF, Motulsky E, Ten Dam-Van Loon NH, Makhoul D, Willermain F, Caspers L (2018) Diagnosis of cytomegalovirus anterior uveitis in two European Referral Centers. Ocul Immunol Inflamm 26(1):116–121. https://doi.org/10.1080/09273948.2017.1411952 CrossRefGoogle Scholar
- 13.Martin Ramirez A, Cardeñoso Domingo L, Gonzalez Guijarro JJ (2018) Ocul Immunol Inflamm Ocul Immunol Inflamm: 1–6. https://doi.org/10.1080/09273948.2018.1438633
- 16.Koizumi N, Inatomi T, Suzuki T, Shiraishi A, Ohashi Y, Kandori M, Miyazaki D, Inoue Y, Soma T, Nishida K, Takase H, Sugita S, Mochizuki M, Kinoshita S, Japan Corneal Endotheliitis Study G (2015) Clinical features and management of cytomegalovirus corneal endotheliitis: analysis of 106 cases from the Japan corneal endotheliitis study. Br J Ophthalmol 99(1):54–58. https://doi.org/10.1136/bjophthalmol-2013-304625 CrossRefGoogle Scholar
- 19.Miyanaga M, Sugita S, Shimizu N, Morio T, Miyata K, Maruyama K, Kinoshita S, Mochizuki M (2010) A significant association of viral loads with corneal endothelial cell damage in cytomegalovirus anterior uveitis. Br J Ophthalmol 94(3):336–340. https://doi.org/10.1136/bjo.2008.156422 CrossRefGoogle Scholar