Acute angle-closure glaucoma with choroidal effusion revealing a hantavirus infection: Description of ultrasound biomicroscopy imagery and optical coherence tomography Visante

Abstract

Purpose: To report a case of bilateral angle-closure associated with systemic hantavirus infection. Materials and methods: A 32-year-old Caucasian man was referred with blurred vision, fever, cough, dyspnea and thrombocytopenia. Ophthalmologic examination revealed myopic shift, elevated intraocular pressure (30 mmHg right eye and 24 mmHg left eye), corneal edema, iridocorneal angle closure and shallow anterior chamber. Ciliochoroidal effusion was detected on anterior segment optical coherence tomography and ultrasound biomicroscopy. Serologic test and polymerase chain reaction confirmed the diagnosis of hantavirus infection and the serotype Puumala. On the sixth day after he started topical anti-glaucoma and cycloplegic medications, the anterior chamber and iridocorneal angles were normalized with disappearance of ciliochoroidal effusion. Conclusion: Puumala hantavirus infection is an exceptional cause of acute bilateral angle-closure combined with ciliochoroidal effusion.

Central Nervous System and Ocular Manifestations in Puumala Hantavirus Infection

“…Kontkanen and Puustjärvi have also reported conjunctival hemorrhages in the case of one female patient with NE [46]. Conjunctival chemosis was noted to some extent in 87% of the eyes in a previous prospective study, in which only one patient suffered bilateral subconjunctival bleeding [4,49]. The acute phase of NE causes an increase in tissue permeability and interstitial hemorrhages.…”

“…Contradictory results of IOP level in patients with NE have been published previously [4,[37][38][39][43][44][45]47,48]. There are some case reports of acute glaucoma attacks associated with NE [37][38][39][48][49][50] and several reports of decreased IOP during the acute phase of NE [4,43,45]. Cho et al have reported a single case of bilateral acute angle-closure glaucoma in Korean hemorrhagic fever, a very severe form of HFRS caused by the Hantaan virus [48].…”

“…In a study by Saari and Luoto, only one out of fifteen NE patients developed acute angle-closure glaucoma [38]. Recently, a case report of a fleeting increase in IOP up to 30 mmHg in the right eye and 24 mmHg in the left eye of a 32-year-old man associated with NE was published [49]. Optical coherence tomography and ultrasound biomicroscopy were used to detect ciliochoroidal effusion and iridocorneal angle-closure as the mechanisms of the bilateral angle-closure glaucoma.…”

Ocular manifestations of emerging viral diseases

“…The underlying mechanism is unclear, but the leading theory involves an anterior shift of the lens due to underlying inflammation of the ciliary body [91]. Anterior shift of the lens may predispose to angle closure glaucoma, reported in exceptional cases, and may be associated with ciliochoroidal effusion [89,92]. In the largest case series (46 patients) to date reporting on ocular involvement in patients who had recovered from acute HFRS, 70% reported ocular symptoms during the disease course, which were often bilateral [93].…”