The Usefulness of Aqueous Fluid Analysis for Epstein–Barr Virus in Patients with Uveitis

Figures & data

TABLE 1. Results of intraocular fluid analyses of 297 patients with uveitis.

	Positive PCR in tested patients	Positive GWC (≥3) in tested patients	Positive GWC (≥3 but <10) in tested patients	Positive (GWC ≥10) in tested patients	Positive PCR and GWC (≥3.0) in tested patients
Herpes simplex virus	10/271 (4%)*	1/257 (<1%)	1/1 (100%)	0	0
Varicella zoster virus	9/271 (3%)	19/258 (7%)	11/19 (58%)	8/19 (42%)	7/245 (3%)
Cytomegalovirus	12/248 (5%)	13/252 (4%)	10/13 (77%)	3/13 (23%)	2/227 (1%)
Epstein–Barr virus	3/201 (1%)	22/245 (9%)	20/22 (91%)	2/22 (9%)	0
Rubella virus	9/183 (5%)	29/192 (15%)	8/29 (28%)	21/29 (72%)	7/167 (4%)
Toxoplasma gondii	6/120 (5%)	12/106 (11%)	6/12 (50%)	6/12 (50%)	3/101 (3%)

PCR, polymerase chain reaction; GWC, Goldmann–Witmer coefficient.

*9/271 (3%) Herpes simplex virus type 1 and 1/272 (<1%) Herpes simplex virus Type 2.

TABLE 2. Characteristics of patients tested for Epstein–Barr virus in intraocular fluids.

	Total	PCR and/or GWC negative	PCR positive for EBV	GWC positive for EBV
Number	297	272/297 (92%)	3/297 (1%)	22/297 (7%)
Age at onset uveitis (mean years ± SD)	46.4 (±18.8)	46.9 (±18.8)	50.7 (±11.8)	40.0 (±17.5)
Gender
Male	121/297 (41%)	112/272 (41%)	1/3 (33%)	8/22 (36%)
Female	176/297 (59%)	160/272 (59%)	2/3 (67%)	14/22 (64%)
Anatomical localization
Anterior	97/297 (33%)	93/272 (34%)	0	4/22 (18%)
Intermediate	26/297 (9%)	26/272 (10%)	0	0/22 (5%)
Posterior	84/297 (28%)	82/272 (30%)	1/3 (33%)	1/22 (5%)
Panuveitis	82/297 (28%)	65/272 (24%)	2/3 (67%)	15/22 (68%)
Scleritis	8/297 (3%)	6/272 (2%)	0	2/22 (9%)

EBV, Epstein–Barr virus; PCR, polymerase chain reaction; GWC, Goldmann–Witmer coefficient; SD, standard deviation.

TABLE 3. Ophthalmologic characteristics of patients positive in polymerase chain reaction for Epstein–Barr virus.

	EBV PCR	EBV GWC	Other PCR+	Other GWC+	IS at moment of aqueous fluid tap	Laterality	Localization	KPs	AU	Iris syn	Vitritis	Fundus	Alternative diagnosis
Patient 1	+*	−	−	−	−	2	Panuveitis	+	+	+	+	MFC	None
Patient 2	+*	−	T. Gondii	−	−	1	Posterior	−	−	−	+	Focal retinal lesion	Toxoplasmosis
Patient 3	+*	−	HIV-2	5.15 (CMV)	HIV+	1	Panuveitis	−	+	+	+	−	HIV-associated uveitis†

EBV, Epstein–Barr virus; GWC, Goldman–Wittmer coefficient; IS, immunosuppression; KP, keratic precipitates; AU, anterior uveitis; syn, synechia; MFC, multifocal chorioretinitis; CMV, cytomegalovirus; HIV, human immunodeficiency virus.

*The PCR for EBV in the serum of these patients was as follows: negative (<100 IU/mL below the limit of detection, patient 1), negative (<100 IU/mL below the limit of detection, patient 2), and positive (<100 IU/mL detectable but below the limit of quantification, patient 3).

†The diagnosis of HIV-induced uveitis was made in this particular patient, as his intraocular HIV 2 loads were repeatedly higher than HIV-2 levels in plasma and uveitis subsided after the introduction of antiretroviral treatment.

TABLE 4. Ophthalmologic characteristics of patients positive for Goldman–Wittmer coefficient of Epstein–Barr virus.

	EBV PCR	EBV GWC	Other PCR+	Other GWC+	IS at moment of aqueous fluid tap	Laterality	Localization	KPs	AU	Iris syn	Vitritis	Fundus	Alternative diagnosis
Patient 1	−	3.44	−	−	−	1	Panuveitis	−	+	−	+	−	None
Patient 2	−	5.50	−	−	−	1	Anterior	−	+	−	−	−	None
Patient 3	−	8.25	−	−	−	2	Panuveitis	+	+	+	+	−	None
Patient 4	−	9.31	−	4.66 (VZV)	−	2	Anterior	−	+	−	−	−	None
Patient 5	−	5.31	−	−	−	2	Anterior	+	+	−	−	−	None
Patient 6	−	41.39	−	−	HIV+	1	Panuveitis	−	−	−	+	POL Vasculitis	Sarcoidosis
Patient 7	−	3.74	−	−	−	2	Panuveitis	−	+	+	+	Granuloma’s	Sarcoidosis
Patient 8	−	7.86	−	−	−	2	Panuveitis	+	+	−*	+	POL	Sarcoidosis
Patient 9	−	9.29	−	−	Adalimumab + prednisolone	2	Panuveitis	+	+	−	+	Peripheral retinal scar	Sarcoidosis
Patient 10	−	11.70	−	−	−	1	Panuveitis	−	+	+	−	POL	Sarcoidosis
Patient 11	−	3.48	−	−	−	2	Panuveitis	+	+	−	+	−	LTBI-associated uveitis
Patient 12	−	4.23	−	−	Adalimumab + methotrexate	2	Panuveitis	−	+	+	+	Vasculitis	HLA-B27+, psoritic arthritis, associated uveitis
Patient 13	−	4.29	−	−	−	2	Panuveitis	+	+	+	+	−	Multiple Sclerosis
Patient 14	0	3.63	+ (CMV)	−	HIV+	1	Panuveitis	+	+	−	+	Occlusive vasculitis	CMV-associated uveitis
Patient 15	−	3.17	+ (Toxoplasmosis)	−	HIV+	1	Panuveitis	+	+	+	+	Retinal detachment	Toxoplasmosis
Patient 16†	−	4.35	+ (RV)	−	−	1	Panuveitis	+	+	−	+	−	RV-associated uveitis
Patient 17	−	4.07	+ (CMV)	260.5 (CMV)	Post kidney- transplantion	2	Posterior	−	−	−	+	CMV-retinitis	CMV-associated uveitis
Patient 18	−	3.43	−	3.43 (HSV)	−	2	Panuveitis	+	+	+	+	−	Multiple sclerosis
Patient 19	0	7.88	−	7.88 (VZV)	−	1	Scleritis	−	−	−	−	−	Varicella Zoster
Patient 20	−	4.63	−	4.63 (VZV)	−	2	Anterior	+	+	−	−	−	Kikuchi’s disease
Patient 21	−	5.06	−	5.06 (VZV)	−	1	Scleritis	+	−	−	−	−	Unknown, clinical suspicion Relapsing polychondritis
Patient 22†	−	4.64	−	5.90 (CMV)	−	1	Panuveitis	−	+	+	+	−	Unknown

EBV, Epstein–Barr virus; PCR, polymerase chain reaction; GWC, Goldman–Wittmer coefficient; KP, keratic precipitates; AU, anterior uveitis; syn, synechia; IS, immunosuppression; HIV, human immunodeficiency virus; POL, punched out lesions; LTBI, latent tuberculosis induced uveitis; HLA-B27, human leukocyte antigen-B27; 0, not performed; CMV, cytomegalovirus; RV, Rubellavirus; HSV, Herpes simplex virus; VZV, Varicella zoster virus; IgG, immunoglobulin G.

*This patient had iris atrophy and iris nodules, without synechiae.

†The aqueous humor tap that was positive for another viral agent than EBV was taken on another date than the aqueous humor tap being positive for PCR and/or GWC EBV.