Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus and Cytomegalovirus
Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus and Cytomegalovirus
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单纯疱疹病毒、水痘带状疱疹病毒和巨细胞病毒引起的前葡萄膜炎的鉴别特征
DOI：
10.1016/j.ajo.2021.03.020
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发表时间：
2021
影响因子：
4.2
通讯作者：
Hase
中科院分区：
文献类型：
--
作者：
Terada Yukiko;Kaburaki Toshikatsu;Takase Hiroshi;Goto Hiroshi;Nakano Satoko;Inoue Yoshitsugu;Maruyama Kazuichi;Miyata Kazunori;Namba Kenichi;Sonoda Koh-Hei;Kaneko Yutaka;Numaga Jiro;Fukushima Masaya;Horiguchi Noe;Ide Mitsunao;Ehara Fumie;Miyazaki Dai;Hase
目的探讨单纯疱疹病毒、水痘-带状疱疹病毒和巨细胞病毒所致前葡萄膜炎(AU)的临床特点。设计多中心病例对照研究。方法对2012年1月至2017年12月在日本11个三级中心就诊并经≥随访3个月的前葡萄膜炎患者进行分析。用聚合酶链式反应(PCR)检测房水中单纯疱疹病毒(HSV)、疱疹病毒(VZV)或巨细胞病毒(CMV)，或眼部带状疱疹的典型体征。结果纳入259例疱疹AU患者，其中单纯疱疹病毒-AU(HSV-AU)30例，疱疹病毒-AU(VZV-AU)50例，巨细胞病毒-AU(CMV-AU)147例，带状疱疹眼部疱疹32例。HSV-AU和VZV-AU患者均为单侧，3%的CMV-AU患者为双侧。HSV-AU和VZV-AU多为急性起病急起，CMV-AU起病隐匿，病程慢性化。HSV-AU和VZV-AU在所有调查的症状、体征和并发症方面均无显著差异。然而，CMV-AU与其他两种疱疹AU类型之间的许多项目都有显著差异。HSV-AU和VZV-AU较CMV-AU更易出现眼部充血和疼痛、视力模糊、睫状体注射、中到大型角膜沉淀物(KPS)、前房内细胞和耀斑以及后粘连。与HSV-AU和VZV-AU相比，CMV-AU组小KPS、硬币状KPS、弥漫性虹膜萎缩、高眼压和青光眼手术的发生率显著增加。结论这项多中心的回顾性研究确定了HSV-AU、VZV-AU和CMV-AU的特征。
PurposeTo determine distinguishing features of the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV).DesignRetrospective, multicenter case series.MethodsConsecutive patients with herpetic AU examined at 11 tertiary centers in Japan between January 2012 and December 2017 and who were followed for ≥3 months were evaluated. Diagnosis was made by polymerase chain reaction (PCR) for HSV, VZV, or CMV in the aqueous humor, or classical signs of herpes zoster ophthalmicus.ResultsThis study enrolled 259 herpetic AU patients, including PCR-proven HSV-AU (30 patients), VZV-AU (50), and CMV-AU (147), and herpes zoster ophthalmicus (32). All HSV-AU and VZV-AU patients were unilateral, while 3% of CMV-AU patients were bilateral. Most HSV-AU and VZV-AU patients were sudden onset with an acute clinical course, while CMV-AU had a more insidious onset and chronic course. There were no significant differences for all surveyed symptoms, signs, and complications between HSV-AU and VZV-AU. However, significant differences were detected for many items between CMV-AU and the other two herpetic AU types. Ocular hyperemia and pain, blurring of vision, ciliary injection, medium-to-large keratic precipitates (KPs), cells and flare in the anterior chamber, and posterior synechia significantly more often occurred in HSV-AU and VZV-AU vs CMV-AU. In contrast, small KPs, coin-shaped KPs, diffuse iris atrophy, elevated intraocular pressure, and glaucoma surgery were significantly more frequent in CMV-AU vs HSV-AU and VZV-AU.ConclusionThis multicenter, retrospective study identified distinguishing features of HSV-AU, VZV-AU, and CMV-AU.