Abstract
Methods:
Files of the 45 patients, who were followed in our clinic due to herpetic anterior uveitis between 1998-2008 were retrospectively reviewed. The diagnosis was made according to clinical findings including; active or inactive keratitis, prior or recent herpetic dermatitis. In cases without clear evidence of recent or preexisting herpetic dermatitis or keratitis; diagnosis was made according to the presence of medium-sized keratic precipitates in a localized or diffuse pattern, iris atrophy, and elevated intraocular pressure.
Results:
There were 24 female and 21 male patients with the mean age of 53.4±17.9 (11- 81) years and with the mean follow-up of 30 (12-114) months. While 35 of the patients had HSV uveitis, 10 patients had VZV uveitis. All of the patients had inflammation in the anterior chamber, 26 patients had keratitis (active or inactive), 20 patients had localized iris atrophy, intraocular pressure was elevated in 24 patients and 10 patients had posterior synechiae. All patients treated with topical steroid and oral antiviral agents. Topical antiviral therapy were given to the 26 patients and oral steroid therapy were given to the 15 patients. Visual acuity increased to a mean of 2.8 line according to the Snellen chart. In two patients, trabeculectomy have been performed because of uncontrolled glaucoma, despite maximum antiglaucomatous therapy. Recurrences occured in 20 patients.
Conclusion:
The diagnosis of herpetic anterior uveitis can be made clinically. Despite recurrent inflammation may involve in all of the anterior segment structures; complications and recurrences can be decreased with correct diagnosis and prompt therapy.
Purpose:
To emphasize the importance of clinical findings in herpetic anterior uveitis and to evaluate treatment modalities.
Keywords: Herpetic uveitis, herpes simplex, herpes zoster, acyclovir
References
Cunningham ET Jr, Diagnosing and treating herpetic anterior uveitis. Ophthalmology Dec107(12): 2129&ndash 2000
Liesegang TJ, Melton LJ, Daly PJ, Ilstrup DM, Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982. Arch Ophthalmol 107:1155&ndash 1989
Weller TH, Varicella and herpes zoster: a perspective and overview. J Infect Dis 166: S1&ndash 1992
Green LK, Pavan-Langston D, Herpes simpleks ocular inflammatory disease. Int Ophthalmol Clin. Spring 46(2): 27&ndash 2006
Siverio Júnior CD, Imai Y, Cunningham ET Jr, Diagnosis and management of herpetic anterior uveitis. Int Ophthalmol Clin Winter 42(1): 43&ndash 2002
Gaynor BD, Margolis TP, Cunningham ET Jr, Advances in diagnosis and management of herpetic uveitis. Int Ophthalmol Clin Spring 40(2): 85&ndash 2000
Kaufman HE, Kanai A, Ellison ED, Herpetic iritis: demonstration of virus in the anterior chamber by fluorescent antibody techniques and electron microscopy. Am J Ophthalmol 71: 465&ndash 1971
Yamamoto S, Pavan-Langston D, Kinoshita S, Detecting herpesvirus DNA in uveitis using the polymerase chain reaction. Br J Ophthalmol 80: 465&ndash 1996
Liesegang TJ, Classification of herpes simplex virus keratitis and anterior uveitis. Cornea 18: 127&ndash 1999
Liesegang TJ, Varicella-zoster virus eye disease. Cornea 18(5): 511&ndash 1999
Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A, Anterior uveitis with sectoral iris atrophy in absence of keratitis:a distinct clinical entity among herpetic eye diseases. Ophthalmology 107: 1164&ndash 2000
Moorthy RS, Mermoud A, Baerveldt G, Minckler DS, Lee PP, Rao NA, Glaucoma associated with üveitis. Surv Ophthalmol 41: 361&ndash 1997
Simsek T, Elgin U, Batman A, Eranil S, Polat S, Zilelioglu O, Herpetik göz hastaligina ikincil glokomlu olgularin klinik bulgulari ve tedavi sonuçlari. MN Oftalmoloji 200714: 28&ndash
Alm A, Grierson I, Shields MB, Side effects associated with prostaglandin analog therapy. Surv Ophthalmol Nov 2008
Ekomatis P, Herpes simplex dendritic keratitis after treatment with latanoprost for primary open angle glaucoma. Br J Ophthalmol Aug 2001,85-1008
Kroll DM, Schumann JS, Reactivation of herpes simplex virus keratitis after initiating bimatoprost treatment for glaucoma. Am J Ophthalmol Mar 2002,133-401
Miserocchi E, Waheed NK, Dios E, et al, Visual outcome in herpes simplex virus and varicella zoster virus uveitis. Ophthalmology. 2002109:1532&ndash
Ertan A, Akova YA, Tayanç E, Aydin P, Herpetik üveitlerde klinik tani ve yaklasim. T. Oft. Gaz. 2002,32-539
Yamamoto S, Pavan-Langston D, Tada R, Yamamoto R, Kinoshita S, Nishida K et al, Possible role of herpes simplex virus in the origin of Posner-Schlossman syndrome. Am J Ophthalmol 119: 796&ndash 1995
Bloch-Michel E, Dussaix E, Cerqueti P, Patarin D, Possible role of cytomegalovirus infection in the etiology of the Posner&ndashSchlossman syndrome. Int Ophthalmol 11:95&ndash 1987
Bonfioli AA, Curi AL, Orefice F, Fuchs' heterochromic cyclitis. Semin Ophthalmol Jul-Sep 2005,20-143
Lonneke AA, , Van der Lelij A, Van der Meer J., Leonoor IL. Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology 114:1358&ndash 2007
Chee SP, Bacsal K, Jap A, Se-Thoe S, Cheng C, Tan BH, Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol 145: 834&ndash 2008
Wong KW, D’Amico DJ, Hedges TR III, et al, Ocular involvement associated with chronic Epstein-Barr virus infection. Br J Ophthalmol 73: 1002&ndash 1989
Rosen PH, Spalton DJ, Graham EM, Intraocular tuberculosis. Eye 4: 486&ndash 1990
Garner A, Pathology of ocular onchocerciasis: human and experimental. Trans R Soc. Trop Med Hyg 70:374&ndash 1976
Karacorlu MA, Cakiner T, Saylan T, Corneal sensitivity and correlations between decreased sensitivity and anterior segment pathology in ocular leprosy. Br J Ophthalmol 75: 117&ndash 1991
Shwartz LK, O’Connor GR, Secondary syphilis with iris papules. Am J Ophthalmol 1980,90
Obenauf CD, Shaw HE, Sydnor CF, et al, Sarcoidosis and its ophthalmic manifestations. Am J Ophthalmol 1978,86
Walton RC, Ball SF, Joffrion VC, Glaucoma in Hansen disease.Br J Ophthalmol 1991,75
Rodriguez A, Power WJ, Neves RA, et al, Recurrence rate of herpetic uveitis in patients on long-term oral acyclovir. Doc Ophthalmol 90: 331&ndash 1995
The herpetic eye disease study group (HEDS), Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med 1998,339-300
Hoang-Xuan T, Büchi ER, Herbort CP, et al, Oral acyclovir for herpes zoster ophthalmicus. Ophthalmology Jul 1992,99-1062
Wood MJ, Johnson RW, McKendrick MW, et al, A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 330: 896&ndash 1994
Wand M, Gilbert CM, Liesegang TJ, Latanoprost and herpes simplex keratitis. Am J Ophthalmol 127:602&ndash 1999


