J Korean Ophthalmol Soc.  2019 Dec;60(12):1162-1168. 10.3341/jkos.2019.60.12.1162.

Clinical Manifestations and Outcomes of Varicella-zoster Virus Endotheliitis

• Cho YW
• Lee DW
• Kim GN
• Kim HA
• Kim SJ

• KMID: 2466166
• DOI: http://doi.org/10.3341/jkos.2019.60.12.1162

Abstract

PURPOSE
We evaluated the clinical manifestations of varicella-zoster virus (VZV)-induced endotheliitis and treatment outcomes.
METHODS
We retrospectively reviewed the medical records of patients exhibiting clinical manifestations of endotheliitis diagnosed as VZV endotheliitis via polymerase chain reaction (PCR) of anterior chamber puncture fluid from January 2013 to December 2018. Their clinical characteristics, treatments, and outcomes were analyzed.
RESULTS
Seven eyes of seven patients were diagnosed as VZV-affected via PCR of the aqueous humor. Mean patient age was 70.4 ± 10.4 years and the average follow-up time 24.7 ± 3.8 months. All eyes exhibited mild anterior chamber inflammation (trace to 1+). Four eyes were disciform in shape and three exhibited diffuse endotheliitis. Six patients evidenced intraocular pressures >21 mmHg. All patients were treated with oral antiviral agents; they were cured and no recurrence was noted. The mean best-corrected visual acuity (logMAR) increased significantly from 0.73 ± 0.19 to 0.09 ± 0.07 and the mean ocular pressure decreased significantly from 26.1 ± 7.3 to 13.2 ± 2.1 mmHg.
CONCLUSIONS
VZV endotheliitis may present as mild inflammation of the anterior chamber with a disciform eye or diffuse corneal edema. Diagnosis is aided by VZV-specific PCR of anterior chamber fluid; oral antiviral agents are useful. Be diagnosed with PCR of anterior chamber, and be treated with oral antiviral agents.

Keyword

Acyclovir; Endotheliitis; Varicella-zoster virus

MeSH Terms

Acyclovir
Anterior Chamber
Antiviral Agents
Aqueous Humor
Corneal Edema
Diagnosis
Follow-Up Studies
Herpesvirus 3, Human*
Humans
Inflammation
Intraocular Pressure
Medical Records
Polymerase Chain Reaction
Punctures
Recurrence
Retrospective Studies
Visual Acuity
Acyclovir
Antiviral Agents

Figure

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  Figure 1 Clinical photographs of patients 5. Slit lamp photograph showed corneal edema and multiple keratic precipitates at initial visit (A). Slit lamp photograph showed decreased corneal edema and keratic precipitates after the antiviral treatment (B). Corneal central thickness decreased from 632 µm to 558 µm after the treatment (C, D). Decreased number, polymegathism, and hypo-reflectivity of corneal endothelial cells were observed in specular microscopy (E). Multiplex polymerase chain reaction showed positive with VZV in aqueous humor (F). CD = cell density; CMV = cytomegalovirus; HHV6 = human herpes virus 6; EBV = Epstein-Barr virus; VZV = Varicella-zoster virus; HSV1, 2 = herpetic simplex virus 1, 2; IC = internal control; PC = positive control; NC = negative control.

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  Figure 2 Initial slit lamp photographs of patients 1 to 4. Slit lamp photograph showed diffuse corneal edema and keratic precipitates in the eye of patient 1 with paralytic mydriasis (A, B). Disciform corneal edema and mutton-fat keratic precipitates were observed in the eye of patient 2 with paralytic mydriasis (C, D). Iris atrophy and keratic precipitates were observed in the eye of patient 3 (E, F). Disciform corneal edema and pseudodendritic lesion, keratic precipitates were observed in the eye of patient 4 (G, H).

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  Figure 3 Initial slit lamp photographs of patients 5 to 7. Slit lamp photograph showed diffuse corneal edema and mutton-fat keratic precipitates in the eye of patient 5 (A, B). Corneal edema and keratic precipitates were observed in the eye of patient 6 (C, D). Disciform corneal edema and mutton-fat keratic precipitates were observed in the eye of patient 7 (E, F).

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