The Use of CSF Multiplex PCR Panel in Patients with Viral Uveitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Molecular Diagnostics

Background:

• Polymerase chain reaction (PCR) testing of ocular fluids is crucial for diagnosing infectious uveitis.
• Multiplex PCR kits for ophthalmic use are not widely available, particularly in Korea.
• Cerebrospinal fluid (CSF) and aqueous humor share biochemical similarities, suggesting potential for cross-application of diagnostic assays.

Purpose of the Study:

• To evaluate the diagnostic utility of a commercially available CSF multiplex PCR panel for detecting herpesviruses in patients with suspected viral uveitis.
• To assess the feasibility and reliability of using a CSF-based multiplex PCR assay for ophthalmic infections.
• To compare PCR positivity rates and virus prevalence in different types of viral uveitis.

Main Methods:

• Retrospective review of medical records and aqueous humor samples from patients with suspected viral uveitis (May 2019 - June 2023).
• Analysis using a multiplex PCR assay originally designed for CSF (Seeplex Meningitis-V1 ACE Detection kit).
• Assay targeted herpes simplex virus types 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6).
• Patients categorized into anterior uveitis, acute retinal necrosis (ARN), and CMV retinitis groups.

Main Results:

• Overall PCR positivity rate was 38.4% among 86 analyzed samples.
• PCR positivity varied significantly by group: 19.7% for anterior uveitis, 93.8% for ARN, and 66.7% for CMV retinitis.
• CMV was the most common pathogen in anterior uveitis and CMV retinitis groups; VZV predominated in the ARN group. No HHV-6 detected.

Conclusions:

• The CSF-based multiplex PCR panel is a feasible and cost-effective diagnostic tool for sight-threatening posterior segment infections like ARN and CMV retinitis.
• The assay demonstrated comparable diagnostic reliability for ARN and CMV retinitis to previous reports.
• Lower positivity in anterior uveitis may stem from limited sample volume; further optimization is recommended for this group.