Clinical Manifestations and Outcomes of Varicella-zoster Virus Endotheliitis

Abstract

Purpose: We evaluated the clinical manifestations of varicella-zoster virus (VZV)-induced endotheliitis and treatment outcomes. Methods: We retrospectively reviewed the medical records of patients exhibiting clinical manifestations of endotheliitis diagnosed as VZV endotheliitis via polymerase chain reaction (PCR) of anterior chamber puncture fluid from January 2013 to December 2018. Their clinical characteristics, treatments, and outcomes were analyzed. Results: Seven eyes of seven patients were diagnosed as VZV-affected via PCR of the aqueous humor. Mean patient age was 70.4 +/- 10.4 years and the average follow-up time 24.7 +/- 3.8 months. All eyes exhibited mild anterior chamber inflammation (trace to 1+). Four eyes were disciform in shape and three exhibited diffuse endotheliitis. Six patients evidenced intraocular pressures >21 mmHg. All patients were treated with oral antiviral agents; they were cured and no recurrence was noted. The mean best-corrected visual acuity (logMAR) increased significantly from 0.73 +/- 0.19 to 0.09 +/- 0.07 and the mean ocular pressure decreased significantly from 26.1 +/- 7.3 to 13.2 +/- 2.1 mmHg. Conclusions: VZV endotheliitis may present as mild inflammation of the anterior chamber with a disciform eye or diffuse corneal edema. Diagnosis is aided by VZV-specific PCR of anterior chamber fluid; oral antiviral agents are useful. Be diagnosed with PCR of anterior chamber, and be treated with oral antiviral agents.