The Usefulness of Aqueous Fluid Analysis for Epstein–Barr Virus in Patients with Uveitis

Abstract

Purpose: To determine characteristics of patients with laboratory findings indicative of intraocular Epstein-Barr-virus (EBV) infection and to establish the usefulness of the laboratory analysis in patients with uveitis. Methods: Retrospective study of patients who underwent diagnostic aqueous fluid analysis. Diverse demographic data of patients were registered. Results: EBV-PCR tested positive in 3/201 (1%) and EBV-GWC in 22/245 (9%). The prevalence of immunosuppression was similar in EBV positive (by PCR/GWC) and EBV negative patients (7/25; 28% vs. 50/272;18%, P = 0.29). Out of all 22 EBV-GWC positive patients, GWC was between 3 and 10 in 91%. In total, 14 patients had laboratory results indicating only EBV infection. Patients without an alternative explanation for uveitis (6/14; 43%) had a chronic recurrent course and good visual prognosis. Conclusion: Low EBV-GWC values combined with multiple positive GWC and/or PCR for other infectious agents. Intraocular assessment for EBV in the initial examination of uveitis patients has limited value.

Anterior segment OCT findings and atypical refractive changes secondary to Epstein-Barr virus–associated nummular keratitis

“…7 Although polymerase chain reaction testing could have definitively proved the diagnosis of EBV, we chose not to perform this invasive procedure in a pediatric patient, especially given the controversy regarding its value in testing intraocular fluids. 8 Given the aforementioned laboratory testing results, we formulated our management based on the positive anti-EBV IgG titers and AS-OCT findings, discussed further in detail.…”

Epstein-Barr virus uveitis after intravitreal triamcinolone injection

“…Sampling of aqueous humor of uveitic eyes revealed a low PCR yield for EBV (1%) in a Netherlands study of 297 patients. 4 However, concurrent positive results for other viruses, most commonly varicella-zoster virus, were often found in patients with positive EBV in aqueous humor. 4 This was one of the study's findings, leading the authors to conclude that intraocular assessment for EBV in uveitis patients has limited value.…”

“…Fourteen patients had results indicating only EBV infection with no alternative explanation for uveitis for six patients. 4 Clinical signs of these patients included anterior chamber inflammation with small KPs and severe vitritis with no involvement of the retina or choroid. All six patients had a chronic, recurrent course of inflammation.…”

The role of antibody indexes in clinical virology

“…Finally, another herpes virus that deserves mention is EBV. EBV DNA is found in AH of up to 17% of patients with uveitis, but also in 7% of non-uveitis controls [35]. A positive EBV GWC is frequently found in combination with positive GWC or PCR results for other pathogens [35].…”

“…EBV DNA is found in AH of up to 17% of patients with uveitis, but also in 7% of non-uveitis controls [35]. A positive EBV GWC is frequently found in combination with positive GWC or PCR results for other pathogens [35]. The role of EBV as an ocular pathogen remains unclear and a positive GWC should be interpreted with care [35].…”