A case of uveitis and retinal vasculitis induced by varicella-zoster virus: vitrectomy treatment and literature review.

backgroundInfectious uveitis can be induced by a variety of factors, including viral, bacterial, and parasitic infections, among others. Among these, viral infections are the most common cause of infectious uveitis. Traditional diagnostic methods have limited sensitivity and are often cumbersome, which restricts their ability to accurately identify the viral pathogens responsible. As a result, there is still no gold-standard diagnostic tool for detecting uveitis. With advancements in molecular diagnostic technologies, metagenomic next-generation sequencing (mNGS) has become widely used in clinical sample detection, molecular sequencing, and microbial analysis. CASE REPORT: This article reports a case of an elderly male patient who presented with a one-month history of left eye vision deterioration. The patient had a generally healthy status, with a 17-year history of hypertension, and denied any other underlying conditions. Ophthalmic examination showed planktonic cells (+++) in the anterior chamber of the left eye, partial posterior adhesion of the iris, lens opacity, visible attachment of iris pigments in front, severe vitreous opacity, visible flocculent yellow white floating material, and faintly visible optic disc structure in the fundus. These findings led to a diagnosis of left eye uveitis. Given the severity of the ocular condition, a decision was made to perform vitreous cavity puncture for smear culture and metagenomic mNGS to identify the pathogen. mNGS promptly detected 9939 sequence counts of Varicella-zoster virus (VZV), confirming the pathogen. Following the identification, Acyclovir injection is used for systemic intravenous injection and local intravitreal injection of ganciclovir injection for antiviral therapy.After two weeks of treatment, the symptoms of anterior uveitis showed some improvement, but the vitreous inflammation remained largely unchanged. Consequently, a vitreous body removal (vitrectomy) was performed, postoperative fundus examination showed the refractive interstitium is clear, and Kyrieleis plaques along the inner wall of the paraoptic artery can be seen. Postoperatively, the patient’s vision improved rapidly. Previous reports typically emphasize the importance of antiviral therapy. However, in this case, the authors discuss the use of vitrectomy in a VZV infection-induced pan-uveitis and retinal vasculitis patient, where antiviral therapy alone was insufficient, resulting in a satisfactory outcome post-surgery.

conclusionIntraocular fluid metagenomic testing is an effective method for diagnosing unexplained uveitis. For patients with VZV-associated uveitis and severe vitreous opacity, early vitrectomy is an effective therapeutic approach.