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Loubsens E, Adam R, Debard A, Barioulet L, Varenne F, Fournié P, Sales de Gauzy T, Ollé P, Martin-Blondel G, Soler V. First-line management of necrotizing herpetic retinitis by prioritizing the investigation of immune status and prognostic factors for poor visual outcomes. Int Ophthalmol 2023:10.1007/s10792-023-02656-8. [PMID: 36920634 DOI: 10.1007/s10792-023-02656-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE To review management, treatment, and outcomes of patients with necrotizing herpetic retinitis (NHR) to propose an algorithm for first-line management of NHR. METHODS Retrospective evaluation of a series of patients with NHR at our tertiary center between 2012 and 2021 using demographic, clinical, ophthalmologic, virological, therapeutic, and prognostic characteristics was performed. Patients were classified by NHR type: acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis. RESULTS Forty-one patients with NHR were included: 59% with ARN, 7% with PORN, and 34% with CMV retinitis. All patients with CMV retinitis and PORN were immunocompromised versus 21% of patients with ARN. CMV infection was found in 14 (34%) patients, varicella zoster virus infection in 14 (34%) patients, herpes simplex virus type 2 infection in 8 (20%) and type 1 infection in 5 (12%) patients. Intravenous antiviral therapy was received by 98% of patients and intravitreal antiviral injections by 90% of patients. The overall complication rate during follow-up was 83% of eyes. Most frequent complications were retinal detachment (33% eyes) and retinal break (29% eyes). Prognostic factors for poor visual outcomes were pre-existing monocular vision loss in contralateral eye among 17% of patients, bilateral NHR in 17% of patients, posterior pole involvement in 46% of eyes, and involvement > 2 retinal quadrants in 46% of eyes. CONCLUSIONS The visual prognosis of patients with NHR remains poor. Prompt investigation of immune status and presence of factors justifying intravitreal antiviral injections must be prioritized to initiate and adapt management while awaiting causative virus confirmation.
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Affiliation(s)
- Emmanuelle Loubsens
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Raphaël Adam
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Alexa Debard
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Lisa Barioulet
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Fanny Varenne
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Pierre Fournié
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France.,University of Toulouse III, Toulouse, France
| | - Thomas Sales de Gauzy
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Priscille Ollé
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.,University of Toulouse III, Toulouse, France.,INSERM U1043-CNRS UMR 5282, Centre for Physiopathology of Toulouse-Purpan, Toulouse, France
| | - Vincent Soler
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France. .,University of Toulouse III, Toulouse, France.
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Bidgoli S, Koch P, Caspers L. [Toxoplasmic chorioretinitis: positive PCR on vitreous with negative serology for Toxoplasma gondii]. J Fr Ophtalmol 2011; 34:384.e1-5. [PMID: 21492958 DOI: 10.1016/j.jfo.2011.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 12/25/2010] [Indexed: 11/25/2022]
Abstract
Ocular recurrences of congenital toxoplasmosis usually occur during the first and second decades of life. At that time, serum levels of IgG against toxoplasmosis are almost always detectable because of the very high sensitivity of the test. The diagnosis is mainly supported by the ophthalmological examination and the good clinical response to treatment. In atypical cases, the Goldman-Witmer coefficient (GWC) on aqueous and polymerase chain reaction (PCR) on aqueous or vitreous is usually performed to substantiate the diagnosis. We report a case of recurrent macular chorioretinitis in a 13-year-old immunocompetent patient with a history of congenital toxoplasmosis whose repeated serologies remained negative or uncertain. However, the diagnosis of toxoplasmic chorioretinitis was supported by the detection of Toxoplasma gondii DNA by PCR analysis in a vitreous sample. Although the sensitivity of serology is very high, it is not perfect and there are false-negative results. In case of high clinical presumption in spite of a negative serology, PCR could be a helpful contribution to the diagnosis.
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Affiliation(s)
- S Bidgoli
- Service d'ophtalmologie, CHU Saint-Pierre, université Libre de Bruxelles, rue Haute-322, 1000 Bruxelles, Belgique.
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