Cytomegalovirus anterior uveitis in immunocompetent individuals following topical prostaglandin analogues
© Babu and Murthy; licensee Springer. 2013
Received: 21 May 2013
Accepted: 2 July 2013
Published: 9 July 2013
The aim of this study is to report two interesting cases of cytomegalovirus (CMV) anterior uveitis following topical prostaglandin analogue administration for glaucoma. Two retrospective case studies are presented.
A 40-year-old immunocompetent lady with a history of Fuchs heterochromic iridocyclitis with secondary glaucoma in the right eye since 2005 was diagnosed to have CMV anterior uveitis by a multiplex polymerase chain reaction (PCR) in 2009. She developed a reactivation of anterior uveitis following the addition of latanoprost 0.005% eye drops unknowingly by her local ophthalmologist. The pattern of endothelial deposits seen with this reactivation of uveitis was different from that seen in earlier or in subsequent reactivations. A 46-year-old immunocompetent lady with a history of primary open-angle glaucoma and no history of uveitis presented with anterior uveitis with medium-sized keratic precipitates following administration of travatoprost 0.004% eye drops. In both cases, the CMV antigen was demonstrated in the aqueous by multiplex PCR at the time of reactivation. Both cases required treatment with dexamethasone eye drops, ganciclovir 1% gel and oral valganciclovir for the control of inflammation along with antiglaucoma medications.
We report two immunocompetent cases with the development of CMV-related anterior uveitis following administration with prostaglandin analogues. These cases increase the awareness of CMV anterior uveitis in immunocompetent individuals and the need to use prostaglandin analogues with caution.
Topical prostaglandin analogues used to treat glaucoma are known to cause exacerbations of uveitis [1, 2]. Reactivation of herpex simplex keratitis following its use has been described in the literature . We report two interesting cases of cytomegalovirus (CMV) anterior uveitis in immunocompetent individuals following administration of topical prostaglandin analogues. To our knowledge, this is the first case series of reactivation of CMV following topical prostaglandin analogues (Medline search).
CMV is known to cause anterior uveitis in immunocompetent patients [4–6]. Reactivation of CMV anterior uveitis has been reported following fluocinolone-sustained steroid drug delivery implant . Our first case had a prior history of CMV anterior uveitis and was started on latanoprost leading to reactivation of anterior uveitis. The pattern of multiple map-like lesions on the endothelium along with keratic precipitates was seen only during the reactivation following the prostaglandin analogues (Figure 1C was different compared to that seen in Figure 1A,D). The second case did not have a history of uveitis and developed a CMV anterior uveitis only after administration of travoprost eye drops. In both cases, the serology showed increased titres of CMV IgG. We speculate that CMV remains latent in the anterior chamber in some individuals, and this may reactivate when the local milieu is altered, such as with the administration of prostaglandin analogues. Ophthalmologists must be aware of this presentation of CMV anterior uveitis following usage of prostaglandin analogues.
- Alm A, Grierson I, Shields MB: Side effects associated with prostaglandin analog therapy. Surv Ophthalmol 2008,53(Suppl 1):S93–105.PubMedView ArticleGoogle Scholar
- Kumarasamy M, Desai SP: Anterior uveitis is associated with travoprost. BMJ 2004,329(7459):205. 10.1136/bmj.329.7459.205PubMed CentralPubMedView ArticleGoogle Scholar
- Kroll DM, Schuman JS: Reactivation of herpes simplex virus keratitis after initiating bimatoprost treatment for glaucoma. Am J Ophthalmol 2002, 133: 401–403. 10.1016/S0002-9394(01)01360-5PubMedView ArticleGoogle Scholar
- Sims JL, Chee SP: Cytomegalovirus endotheliitis following fluocinolone acetonide (Retisert) implant. Eye 2010, 24: 197–198.PubMedView ArticleGoogle Scholar
- Chee SP, Bacsal K, Jap A, et al.: Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol 2008,145(5):834–840. 10.1016/j.ajo.2007.12.015PubMedView ArticleGoogle Scholar
- Chee SP, Jap A: Cytomegalovirus anterior uveitis: outcome of treatment. Br J Ophthalmol 2010,94(12):1648–52. 10.1136/bjo.2009.167767PubMedView ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.