Clinical characteristics of virus-related uveitic secondary glaucoma: focus on cytomegalovirus and varicella zoster virus

Abstract

Background We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis. Methods In this retrospective study, we enrolled patients with anterior uveitic secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS, and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments. Results We found that 53.2% (25/47) patients with PSS were CMV-positive. Patients with CMV-positive PSS had a larger cup-to-disc ratio (p = .043), lower CEC density (p = .017), more severe CEC loss (p < .001), and more iris depigmentation (p = .006) than CMV-negative PSS patients. Compared with patients with CMV-positive PSS, those with VZV-AUSG were older (p = .003), presented a higher IOP (p = .015), and had poorer BCVA (p < .001). Patients with CMV-positive PSS and VZV-AUSG all accepted ganciclovir treatment, and those with CMV-positive PSS used fewer antiglaucoma agents simultaneously compared with CMV-negative PSS (p = .005) and VZV-AUSG (p < .001). All three groups had a comparable proportion of patients requiring antiglaucoma surgery. Conclusions We observed some distinctive clinical features in CMV-positive PSS compared with CMV-negative PSS. Further, we found that patients with VZV-AUSG presented with a higher IOP and worse visual acuity, and required more antiglaucoma medication than those with CMV-positive PSS.

Quantification of Iris Atrophy by Swept-Source Optical Coherence Tomography in Posner–Schlossman Syndrome

“…Moreover, iris stromal thickness close to the pupillary edge (M500 and M1000) was found to be significantly and positively associated with corneal endothelium density in PSS-affected eyes, indicating that iris stromal thickness close to the pupillary edge might be a clinical predictor of corneal endothelium density loss in PSS. A previous study has reported that in PSS-affected eyes, the higher prevalence of iris changes was always accompanied by the more serious corneal endothelium loss [ 20 ], which was consistent with our study results. Iris stroma was susceptible to CMV [ 21 ] and could be a reservoir for the latency of CMV [ 30 , 31 ].…”

“…Morphological observations of iris in PSS by slit lamp microscopy have been reported previously [ 13 , 14 , 18 , 19 , 20 , 21 , 22 , 23 ]. However, no study has measured the iris dimensions in PSS quantitatively for now.…”

“…Previous studies have suggested that iris atrophy could be observed by slit lamp microscope in PSS [ 13 , 14 , 18 , 19 , 20 , 21 , 22 , 23 ]. Accompanied with iris atrophy, significant pupil dilation could also be observed [ 18 , 29 ], which is consistent with our study results (PSS-affected eyes had thinner iris thickness and larger PD).…”

“…Among the various features of PSS, Kim et al reported that iris involvement (iris atrophy, iris depigmentation, iris thinning) in PSS could be a significant clinical predictor of the requirement for anti-glaucoma surgical intervention, as well as of the worse vision-related quality of life questionnaire scores [ 18 ]. Although several studies have investigated iris involvement in PSS by slit lamp microscope qualitatively [ 13 , 14 , 18 , 19 , 20 , 21 , 22 , 23 ], no studies have performed quantitative measurements of iris dimensions in PSS for now. Considering the important role of iris involvement in PSS [ 18 ], quantitative measurements of iris dimensions might provide us with novel information about PSS.…”

Do Oral Pathogens Inhabit the Eye and Play a Role in Ocular Diseases?

“…A plethora of recent research has indicated the involvement of microbes of extra-ocular origin in the development and prognosis of ophthalmic pathologies ( Table 1 ), which include bacteria, fungi, and viruses. It is noteworthy that more recent studies have identified the association of viral components in eye diseases such as uveitis in chronic infections of hepatitis B and hepatitis C viruses [ 30 , 31 ], cytomegalovirus in AMD [ 32 , 33 ], and glaucoma [ 34 ], and more interestingly, coronavirus (COVID-19) is also implicated in ocular diseases [ 35 , 36 , 37 , 38 ]. Several studies have determined that homeostasis of the ocular surface is directly or indirectly impacted by the complex intestinal microbiome [ 39 ].…”