Clinical Characteristics of Virus-related Uveitic Secondary Glaucoma: Focus on Cytomegalovirus and Varicella Zoster Virus

Background: We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis. Methods: : In this retrospective study, we enrolled 60 patients with secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS (CMV-PSS), and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments. Results: : We found that 25 of the 47 patients with PSS were CMV-positive. Patients with CMV-PSS had a larger cup-to-disc ratio ( p = .043), lower CEC density ( p = .017), and more severe CEC loss ( p < .001). The CMV-positive PSS group had more patients with iris depigmentation ( p = .006). Compared with patients with CMV-PSS, those with VZV-AUSG were older ( p = .003), presented a higher IOP ( p = .015), and had poorer BCVA ( p < .001). Patients with CMV-PSS and VZV-AUSG all accepted ganciclovir treatment, and those with CMV-PSS used fewer antiglaucoma agents simultaneously compared with CMV-negative PSS ( p = .005) and VZV-AUSG ( p < .001). All three groups had a comparable proportion of patients requiring antiglaucoma surgery. Conclusions: : We observed some distinctive clinical features in CMV-PSS that could help clinicians discriminate it from CMV-negative PSS. Further, we found that patients with VZV-AUSG presented a higher IOP and worse visual acuity, and required more antiglaucoma medication than those with CMV-PSS.