Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus, and Cytomegalovirus

center dot PURPOSE: To determine distinguishing features of the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV). center dot DESIGN: Retrospective, multicenter case series. center dot METHODS: Consecutive patients with herpetic AU ex-amined 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 poly-merase chain reaction (PCR) for HSV, VZV, or CMV in the aqueous humor, or classical signs of herpes zoster ophthalmicus. center dot RESULTS: This study enrolled 259 herpetic AU pa-tients, 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 bi-lateral. Most HSV-AU and VZV-AU patients were sud -den 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 her-petic AU types. Ocular hyperemia and pain, blurring of vision, ciliary injection, medium-to-large keratic precipi-tates (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 in-traocular pressure, and glaucoma surgery were signifi-cantly more frequent in CMV-AU vs HSV-AU and VZV-AU. CONCLUSION: This multicenter, retrospective study identified distinguishing features of HSV-AU, VZV-AU, and CMV-AU. (Am J Ophthalmol 2021;227: 191-200. (c) 2021 Elsevier Inc. All rights reserved.)

Automated summary

This study aimed to determine the clinical characteristics of anterior uveitis caused by HSV, VZV, and CMV, finding significant differences between CMV-associated AU and the other two types. Symptoms like ocular hyperemia, pain, blurring of vision, and signs like keratic precipitates were more common in HSV-AU and VZV-AU compared to CMV-AU.