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Ex Vivo Organotypic Corneal Model of Acute Epithelial Herpes Simplex Virus Type I Infection
Published on: November 3, 2012
Polymerase chain reaction for diagnosis of herpetic intraocular inflammation
1Department of Ophthalmology, Tokyo Medical College Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160, Japan.
Abstract:
The authors present a polymerase chain reaction method for rapid and direct diagnosis of herpetic intraocular infections using small volume samples of intraocular fluid from 29 patients with various intraocular inflammatory diseases and 24 controls with senile cataract. Of six patients with early acute retinal necrosis from whom aqueous humor was tested, four were found to be positive for the presence of varicella-zoster (VZV) DNA while the other two were positive for the presence of herpes simplex virus (HSV) DNA. One of the patients with HSV DNA had been tested at an extremely early stage, at which time the aqueous humor viral antibody ratio did not predict a specific viral infection. Among four patients with acute retinal necrosis in relatively late stages following treatment with acyclovir from whom vitreous was obtained and tested, only one was found to have the presence of any viral DNA (VZV). On the other hand, the vitreous viral antibody ratio was found to be predictive of VZV infection in all four cases. VZV DNA was also detected in aqueous humor samples from four patients with suspected herpes zoster anterior uveitis, while HSV DNA was found in the aqueous humor of one patient with nonspecific keratouveitis. Neither human cytomegalovirus DNA nor human herpesvirus-6 DNA was detected in any sample included in this study. Finally, Epstein-Barr virus DNA was detected in the aqueous humor of the majority of patients studied and identified in cataract patients as well, suggesting either low specificity of the authors' assay for this virus or ubiquity of this virus in human eyes. In summary, the PCR method proved to be a very useful tool in establishing an etiological diagnosis in patients in the early stages of acute retinal necrosis, and in patients with anterior uveitis due to suspected HSV or VZV infection.
Insights
Polymerase chain reaction (PCR) rapidly diagnoses herpetic intraocular infections. This method is highly effective for early acute retinal necrosis and anterior uveitis caused by herpes simplex virus (HSV) or varicella-zoster virus (VZV).
Area of Science:
- Ophthalmology
- Virology
- Molecular Biology
Background:
- Herpetic intraocular infections pose diagnostic challenges.
- Early and accurate etiological diagnosis is crucial for effective treatment.
- Conventional methods may not always be sufficiently sensitive or specific.
Purpose of the Study:
- To evaluate the utility of polymerase chain reaction (PCR) for direct and rapid diagnosis of herpetic intraocular infections.
- To compare PCR results with viral antibody ratios in intraocular fluid.
- To identify the causative viral agents in patients with intraocular inflammation.
Main Methods:
- A PCR assay was developed and applied to small volumes of intraocular fluid (aqueous humor and vitreous).
- Samples were obtained from 29 patients with intraocular inflammatory diseases and 24 controls.
- Viral DNA detection was performed for herpes simplex virus (HSV), varicella-zoster virus (VZV), human cytomegalovirus, human herpesvirus-6, and Epstein-Barr virus.
Main Results:
- PCR detected VZV DNA in four early acute retinal necrosis (ARN) cases and HSV DNA in two early ARN cases.
- In late-stage ARN, only one of four patients showed VZV DNA in vitreous, while antibody ratios were predictive in all four.
- VZV DNA was found in four cases of suspected herpes zoster anterior uveitis, and HSV DNA in one case of keratouveitis.
Conclusions:
- PCR is a valuable tool for the early etiological diagnosis of acute retinal necrosis.
- The PCR method aids in diagnosing anterior uveitis suspected to be caused by HSV or VZV.
- PCR offers rapid and direct detection of viral DNA in intraocular samples, improving diagnostic accuracy.
