Study Delineates Anterior Uveitis Associated With Cytomegalovirus, Other Etiologies

Varicella zoster virus (VZV) particle, colored transmission electron micrograph (TEM)
Varicella zoster virus (VZV) particle, coloured transmission electron micrograph (TEM). VZV is a member of the Herpes virus family and causes human chickenpox and shingles. Each particle (virion) consists of a deoxyribonucleic acid (DNA) core (blue) surrounded by an icosahedral capsid (purple), which is itself surrounded by a glycoprotein envelope (pale ring). Magnification: x110,000 when printed 10 centimetres wide.
Cytomegalovirus and Varicella Zoster Virus-Related Uveitic Secondary Glaucoma.

Compared with patients with cytomegalovirus (CMV)-negative Posner-Schlossman syndrome (PSS), patients with CMV-positive PSS have a larger cup-to-disc ratio, more severe corneal endothelial cell (CEC) count loss, and greater iris depigmentation, according to the results of a study published in BMC Ophthalmology. Individuals with CMV-positive PSS also demonstrate distinctive features from those with varicella zoster virus (VZV)-related disease, the study shows.

Researchers conducted a retrospective study to analyze the clinical characteristics of anterior uveitic secondary glaucoma (AUSG) related to CMV and varicella zoster virus (VZV).

Patients with AUSG were recruited for the study and underwent aqueous and serum analyses for viral antibodies. The researchers evaluated age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), CEC count, ocular morphological changes, and medical treatments.

A total of 60 patients (61.7% men and 38.3% women, mean age at onset 32.1 years), were included in the study. Among them, 53.5% had CMV-positive PSS, 21.7% had VZV-AUSG, and 36.7% had CMV-negative PSS.

The researchers found that patients with CMV-positive PSS had a larger cup-to-disc ratio (mean, 0.6 vs 0.5; P =.043), lower CEC density (2196.3 vs 2490.6 cells/mm2; P =.017), more severe relative CEC loss (22.1 vs 9.6%; P <.001), and more iris depigmentation (80 vs 40.9%; P =.006) than CMV-negative PSS patients. 

They also found that patients with VZV-AUSG were older (mean, 55.1 vs 39.0; P =.003), presented a higher IOP (32.2 vs 29.0 mm Hg; P =.015), and had poorer BCVA (0.8 vs 0.3 logMAR; P <.001) than patients with CMV-positive PSS. 

All patients with CMV-positive PSS and VZV-AUSG received ganciclovir treatment. Patients with CMV-positive PSS required fewer simultaneous antiglaucoma agents than patients with CMV-negative PSS (1.0 vs 2.0; P =.005) and those with VZV-AUSG (1.0 vs 2.4; P <.001). The proportions of patients requiring antiglaucoma surgery were similar among the groups.

Limitations of the study included the retrospective design, initiation of observation at uveitis-related secondary glaucoma, a relatively short follow-up time, inability to observe potential complications with further progression, relatively small sample sizes, and lack of PCR confirmation tests for CMV and VZV DNA.


Fan X, Li Z, Zhai R, Sheng Q, Kong X. Clinical characteristics of virus-related uveitic secondary glaucoma: focus on cytomegalovirus and varicella zoster virus. BMC Ophthalmol. 2022;22(1):130.doi:10.1186/s12886-022-02348-4