| Journal: | Revista do Instituto de Medicina Tropical de Sao Paulo |
| Database: | |
| System number: | 000537161 |
| ISSN: | 0036-4665 |
| Authors: | dos Reis, Caroline1 Miranda, Bruno Avelar1 da Cunha Afonso, Aloysio Fellet1 Malta e Cunha, Leandro H.1 Trindade, Bruno Cançado2 Vasconcelos Santos, Daniel Vitor1 |
| Institutions: | 1Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte, Minas Gerais. Brasil 2Instituto de Oftalmologia Cançado Trindade, Belo Horizonte, Minas Gerais. Brasil 3Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, Minas Gerais. Brasil 4Instituto da Visão, Belo Horizonte, Minas Gerais. Brasil |
| Year: | 2021 |
| Volumen: | 63 |
| Country: | Brasil |
| Language: | Inglés |
| English abstract | Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses that are well-known agents of keratitis, anterior uveitis, scleritis and retinitis. CMV is usually associated with ocular diseases in immunosuppressed individuals, with a notable exception of hypertensive anterior uveitis with distinctive clinical features in immunocompetent patients. This syndrome was characterized in the last two decades in Europe and Southeast Asia, and then documented in the rest of world. Definitive diagnosis in these cases is usually made by Polymerase Chain Reaction (PCR) of the anterior chamber fluid. We report three immunocompetent Brazilian adults with history of multiple glaucomatocyclitic crises and presenting with chronic hypertensive anterior uveitis invariably with mild anterior chamber inflammation and characteristic scarce nummular keratic precipitates. CMV DNA was successfully amplified and detected in the aqueous humor of all patients. Corneal endothelial counts were significantly reduced in the involved eyes, with one patient developing bullous keratopathy. All patients were then treated with topical ganciclovir gel and corticosteroids, with subsequent control of the intraocular inflammation. CMV may represent an overlooked / underestimated etiology of hypertensive anterior uveitis that may progressively lead to endothelial dysfunction, culminating in bullous keratopathy. Management of patients is challenging, with the potential use of topical antivirals to decrease the number of relapses, and corticosteroids to control anterior uveitis / endotheliitis and to protect the corneal endothelium. |
| Keyword: | Cytomegalovirus, Anterior uveitis, Glaucomatocyclitic crisis, Hypertensive anterior uveitis |
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