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Hoogewoud F, Rossi DC, Stappler T, Guex-Crosier Y. Acute retinal necrosis: A mini review. FRONTIERS IN OPHTHALMOLOGY 2022; 2:916113. [PMID: 38983554 PMCID: PMC11182167 DOI: 10.3389/fopht.2022.916113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/04/2022] [Indexed: 07/11/2024]
Abstract
Acute retinal necrosis is a rare but potentially devastating disease. Even in the era of modern medicine, retinal detachment is a frequent complication leading to vison loss, as well as phthisis bulbi. Whereas IV acyclovir still remains the standard of care, high doses of valacyclovir with/without additional intravitreal injections of foscarnet have been used. In an attempt to reduce the retinal detachment rate, prophylactic laser treatment and early vitrectomy have been proposed. In this article, we aim to review current diagnostic and treatment modalities.
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Cox JT, Miller JB. Retinal Detachment Associated With Acute Retinal Necrosis. Int Ophthalmol Clin 2022; 62:157-172. [PMID: 35325917 DOI: 10.1097/iio.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Mapelli C, Milella P, Donà C, Nassisi M, Osnaghi S, Viola F, Agostoni C, Minoia F, Filocamo G. Acute Retinal Necrosis: Clinical Features, Diagnostic Pitfalls, Treatment, and Outcome of an Insidious Disease in Children. Case Report and Review of the Literature. Front Pediatr 2022; 10:854325. [PMID: 35433555 PMCID: PMC9010776 DOI: 10.3389/fped.2022.854325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to explore clinical features, diagnostic work-up, treatment, and outcomes of pediatric patients with acute retinal necrosis (ARN), and to propose a standardized management of this condition in childhood. METHODS Clinical manifestations, diagnostic work-up, and treatment of three pediatric cases with ARN were analyzed. Furthermore, a review of the literature was performed from January 1990 to November 2021, focused on 1) clinical presentation; 2) differential diagnosis, including both infectious and non-infectious conditions; 3) key role of diagnostic techniques; and 4) currently available treatments. RESULTS Data from 72 children with ARN (69 from literature and 3 from our center) were analyzed. The most frequent presenting symptoms were red eye resistant to topical treatment (57%) and altered vision (58%), 25 patients had bilateral involvement. In 30% a known history of herpetic infection was reported. PCR testing on anterior chamber and/or vitreous sampling was performed in 46 cases (64%) and was diagnostic in 88% of them, with herpes simplex virus (HSV) 2 being the most frequently identified pathogen (57%). All patients underwent systemic antiviral therapy (16% only oral); adjunctive intravitreal injections were performed in 21% of them. CONCLUSIONS ARN is a rare but severe ocular infection presenting as a panuveitis with occlusive retinal vasculitis and peripheral retinal necrosis. Varicella-zoster virus and HSV 1-2 are most frequently implicated. Due to a high incidence of rhegmatogenous retinal detachment and optic atrophy, ARN has a poor prognosis with a potentially severe impact on visual function. Although a prompt recognition is crucial to prevent complications, ARN diagnosis in children is still challenging.
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Affiliation(s)
- Chiara Mapelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Paolo Milella
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Caterina Donà
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Nassisi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Silvia Osnaghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Francesco Viola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Minoia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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Soares PVBDS, Nogueira PF, Colombo-Barboza GN, Colombo-Barboza MN, Barioni MFG. Toxoplasmose sistêmica associada à forma ocular bilateral atípica mimetizando necrose retiniana aguda. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Costa de Andrade G, Marchesi Mello LG, Martines GC, Maia A. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN ACUTE RETINAL NECROSIS. Retin Cases Brief Rep 2021; 15:256-260. [PMID: 30048405 DOI: 10.1097/icb.0000000000000778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report clinical features of acute retinal necrosis (ARN) using optical coherence tomography angiography. METHODS A 59-year-old female patient presented with blurred vision in the left eye for 1 day. The patient presented posterior uveitis with multiple peripheral areas of retinal pallor with presumed acute retinal necrosis. Herpes simplex virus Type 1 infection was confirmed after serologic tests, and the polymerase chain reaction analysis of the aqueous humor tested positive. RESULTS The left eye examination revealed anterior chamber reaction, mild vitritis, optic disk swelling, and yellowish white retinal lesions with discrete borders along the superotemporal arcade and temporal periphery. Baseline optical coherence tomography angiography revealed decreased vascular density of superficial and deep plexuses of superotemporal macular region. One month after oral valacyclovir 2,000 mg twice daily, visual acuity and retinal lesions improved, and optical coherence tomography angiography images showed improvement of vascular density. CONCLUSION Occlusive arterial vasculopathy is one of the main clinical characteristics of acute retinal necrosis. We herein describe for the first time the features of retinal vasculature in acute retinal necrosis revealed by optical coherence tomography angiography, showing decreased vascular density of superficial and deep plexuses.
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Affiliation(s)
- Gabriel Costa de Andrade
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Research and Teaching Department, RETINA CLINIC, São Paulo, Brazil ; and
| | - Luiz G Marchesi Mello
- Department of Ophthalmology, Federal University of Espírito Santo (UFES), Espírito Santo, Brazil
| | - Gabriela C Martines
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Research and Teaching Department, RETINA CLINIC, São Paulo, Brazil ; and
| | - André Maia
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Research and Teaching Department, RETINA CLINIC, São Paulo, Brazil ; and
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6
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Jain A, Anantharaman G, Gopalakrishnan M, Narayanan S. Sequential optical coherence tomography images of early acute retinal necrosis. Indian J Ophthalmol 2021; 68:520-522. [PMID: 32057019 PMCID: PMC7043164 DOI: 10.4103/ijo.ijo_255_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aarti Jain
- Department of Vitreo.Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Giridhar Anantharaman
- Department of Vitreo.Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Mahesh Gopalakrishnan
- Department of Vitreo.Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Sandhya Narayanan
- Department of Vitreo.Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
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Mahendradas P, Sridharan A, Kawali A, Sanjay S, Venkatesh R. Role of Ocular Imaging in Diagnosis and Determining Response to Therapeutic Interventions in Posterior and Panuveitis. Asia Pac J Ophthalmol (Phila) 2021; 10:74-86. [PMID: 33512829 DOI: 10.1097/apo.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT This review provides a comprehensive description and careful interpretation of various ocular imaging techniques to visualize the different ocular structures in posterior and panuveitis. This can help in the diagnosis, follow-up, and monitoring the response to treatment in patients with different posterior and panuveitic entities.
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Affiliation(s)
| | - Akhila Sridharan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramesh Venkatesh
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
- Department of Vitreoretinal Services, Narayana Nethralaya, Bangalore, India
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Babiuch AS, Han M, Conti FF, Wai K, Silva FQ, Singh RP. Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion. JAMA Ophthalmol 2019; 137:38-46. [PMID: 30286219 DOI: 10.1001/jamaophthalmol.2018.4484] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Disorganization of retinal inner layers (DRIL) has demonstrated significant correlations with visual acuity (VA) in center-involved diabetic macular edema. In patients with retinal vein occlusion (RVO) and secondary macular edema, DRIL may be a useful biomarker in determining VA outcomes. Objective To examine whether DRIL at baseline and after treatment is associated with VA in RVO. Design, Setting, and Participants A retrospective review of records of 147 patients 18 years or older with treatment-naive branch RVO (BRVO), central RVO (CRVO), or hemispheric RVO (HRVO), with a minimum of 12 months of follow-up, who presented to a tertiary ophthalmic center from December 1, 2010, to January 1, 2016, was conducted. Data collection continued through January 2017. Exclusion criteria included active confounding retinal or ocular disease, history of pars plana vitrectomy, or prior intravitreal injections. Two masked graders calculated a DRIL score based on DRIL presence in 3 predefined regions on spectral-domain optical coherence tomography at baseline, 6 months, and 12 months. A third masked grader was used for discrepancies. Exposures Anti-vascular endothelial growth factor (AVF) therapy (ranibizumab, aflibercept, or bevacizumab) determined by the treating physician. Main Outcomes and Measures The DRIL score at baseline for determining VA outcomes and correlation of VA with changes in DRIL burden in response to AVF therapy. Results In the 147 patients (mean [SD] age, 68.9 [13.1] years; 75 [51.0%] female), baseline DRIL was seen in 91 eyes (61.9%). In the BRVO group but not the CRVO group, baseline DRIL was associated with lower baseline Early Treatment Diabetic Retinopathy Study (ETDRS) score (score of 66.7 for no DRIL vs 54.6 for DRIL, P = .002). Absence of DRIL at baseline in the CRVO/HRVO group correlated with greater VA gains at 6 months, adjusting for baseline VA (score change of 19.50 for no DRIL vs 12.72 for DRIL; P = .04). During 12 months, continued DRIL presence in BRVO was associated with less VA gain up to 6 months (score change of 6.2 for the DRIL increase group vs 18.6 for the DRIL decrease group vs 2.9 for the DRIL stable group; P = .02). Increasing DRIL scores in CRVO/HRVO were associated with reduced VA improvement at 6 months (score change of -0.12 for the DRIL increase group vs 16.90 for the DRIL decrease group vs 8.45 for the DRIL stable group; P = .002) and 12 months (score change of -1.91 for the DRIL increase group vs 17.83 for the DRIL decrease group vs 6.97 for the DRIL stable group; P < .001). Conclusions and Relevance Baseline DRIL presence and DRIL burden changes with AVF therapy for macular edema secondary to RVO may be useful biomarkers of ETDRS score improvements.
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Affiliation(s)
- Amy S Babiuch
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Han
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Felipe F Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Karen Wai
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Rishi P Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Joltikov KA, Sesi CA, de Castro VM, Davila JR, Anand R, Khan SM, Farbman N, Jackson GR, Johnson CA, Gardner TW. Disorganization of Retinal Inner Layers (DRIL) and Neuroretinal Dysfunction in Early Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2019; 59:5481-5486. [PMID: 30452602 PMCID: PMC6735648 DOI: 10.1167/iovs.18-24955] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To elucidate the relationship between disorganization of retinal inner layers (DRILs) and retinal function in diabetic patients without diabetic retinopathy (DR) and with nonproliferative DR, but without diabetic macular edema (DME). Methods Fifty-seven participants with diabetes mellitus (DM) and 18 healthy controls underwent comprehensive ophthalmic examination, fundus photography, and spectral-domain optical coherence tomography. Scans of the fovea were evaluated for the presence of DRIL. Retinal function was evaluated using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, the quick contrast sensitivity function (qCSF) on the AST Sentio Platform, short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), and frequency doubling perimetry (FDP). ANOVA and Kruskal-Wallis were used to compare retinal function in subjects with and without DRIL. Tukey-Kramer test and Wilcoxon were used for post hoc analysis. Results DRIL was identified in 9 of 57 diabetic subjects. DRIL subjects had higher body mass index and longer diabetes duration compared to diabetic subjects without DRIL (P = 0.03 and P = 0.009, respectively). Subjects with DRIL had reduced ETDRS visual acuity (P = 0.003), contrast sensitivity function (P = 0.0003), and SAP performance (PSD, P < 0.0001) compared to controls and diabetic subjects without DRIL. Structural analysis revealed inner retinal thinning, and some outer retinal thinning, associated with DRIL. Conclusions Diabetic subjects with DRIL have reduced retinal function compared to those without DRIL, and defective retinal lamination may be an early cellular consequence of diabetes responsible for this in some patients. Following further longitudinal studies, DRIL may be a readily available and reliable structural biomarker for reduced retinal function in early diabetic neuroretinal disease.
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Affiliation(s)
- Katherine A Joltikov
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Christopher A Sesi
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Vinícius M de Castro
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - José R Davila
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Rohit Anand
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Sami M Khan
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Neil Farbman
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
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Wu XN, Lightman S, Tomkins‐Netzer O. Viral retinitis: diagnosis and management in the era of biologic immunosuppression: A review. Clin Exp Ophthalmol 2019; 47:381-395. [DOI: 10.1111/ceo.13500] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/08/2019] [Accepted: 02/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Xia Ni Wu
- Ophthalmology, Moorfields Eye Hospital London UK
- Faculty of Brain Sciences, Institute of Ophthalmology London UK
| | - Sue Lightman
- Ophthalmology, Moorfields Eye Hospital London UK
- Faculty of Brain Sciences, Institute of Ophthalmology London UK
| | - Oren Tomkins‐Netzer
- Ophthalmology, Moorfields Eye Hospital London UK
- Faculty of Brain Sciences, Institute of Ophthalmology London UK
- Department of OphthalmologyBnai Zion Medical Centre Haifa Israel
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11
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Mano F, LoBue SA, Chang KC, Mano T. Multimodal imaging of retinal metastasis masquerading as an acute retinal necrosis. Int J Retina Vitreous 2018; 4:43. [PMID: 30479836 PMCID: PMC6249976 DOI: 10.1186/s40942-018-0149-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/17/2018] [Indexed: 01/27/2023] Open
Abstract
Background To report the multimodal imaging and histology of a case of metastatic esophageal cancer with vitreoretinal involvement resembling acute retinal necrosis (ARN) in a patient receiving systemic chemotherapy. Case presentation A 69-year-old Japanese man with a history of stage 4 esophageal carcinoma, treated with three cycles of 5-fluorouracil (5-FU) and cisplatin (CDDP) chemotherapy as well as 30 sessions of radiation therapy, presented with new onset of blurry vision in the right eye (OD). Visual acuity was 20/200 OD. Fundus examination OD revealed 2+ nuclear cataract, veil-like vitreous opacity, a tractional retinal detachment, and white retinal lesions in the macula and periphery masquerading as an ARN. Due to the poor view and uncertainty regarding diagnosis, combined cataract extraction and 25 gauge pars plana vitrectomy was performed. Polymerase chain reaction and cytologic analysis were performed on the vitreous samples, which was negative for all infectious entities but positive for poorly differentiated malignant cells. The vitreous biopsy was consistent with the primary endoscopic esophageal biopsy. Ultra-wide view fundus imaging revealed multifocal white intraretinal lesions in the macula and periphery. Optical coherence tomography through these white opacities displayed hyper-reflective inner retinal lesions with no choroidal involvement, suggestive of retinal metastasis. Observation and palliative support was continued until the patient passed away 3 months after diagnosis. Conclusion Retinal metastasis may mimic infectious syndromes such as ARN and are associated with a very poor prognosis. Outside of the retina, no further central nervous system metastasis was found. 5-FU is known to cross the blood–brain-barrier but may be inadequate in preventing retinal metastasis.
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Affiliation(s)
- Fukutaro Mano
- 1Suita Tokushukai Hospital Eye Center, 21-1, Senriokanishi, Suita City, Osaka 565-0814 Japan
| | - Stephen A LoBue
- LoBue Laser and Eye Medical Centers, Temecula, CA USA.,3Lincoln Medical Center, Bronx, NY USA
| | - Kuo-Chung Chang
- 1Suita Tokushukai Hospital Eye Center, 21-1, Senriokanishi, Suita City, Osaka 565-0814 Japan
| | - Tomiya Mano
- 1Suita Tokushukai Hospital Eye Center, 21-1, Senriokanishi, Suita City, Osaka 565-0814 Japan
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Lee JH, Agarwal A, Mahendradas P, Lee CS, Gupta V, Pavesio CE, Agrawal R. Viral posterior uveitis. Surv Ophthalmol 2017; 62:404-445. [PMID: 28012878 PMCID: PMC5654632 DOI: 10.1016/j.survophthal.2016.12.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022]
Abstract
The causes of posterior uveitis can be divided into infectious, autoimmune, or masquerade syndromes. Viral infections, a significant cause of sight-threatening ocular diseases in the posterior segment, include human herpesviruses, measles, rubella, and arboviruses such as dengue, West Nile, and chikungunya virus. Viral posterior uveitis may occur as an isolated ocular disease in congenital or acquired infections or as part of a systemic viral illness. Many viruses remain latent in the infected host with a risk of reactivation that depends on various factors, including virulence and host immunity, age, and comorbidities. Although some viral illnesses are self-limiting and have a good visual prognosis, others, such as cytomegalovirus retinitis or acute retinal necrosis, may result in serious complications and profound vision loss. Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. We review the clinical features, diagnostic tools, treatment regimens, and long-term outcomes for each of these viral posterior uveitides.
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Affiliation(s)
- Joanne H Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aniruddha Agarwal
- Department of Vitreoretina and Uveitis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Cecilia S Lee
- Department of Uveitis, University of Washington, Seattle, Washington, USA
| | - Vishali Gupta
- Department of Vitreoretina and Uveitis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Carlos E Pavesio
- Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom; Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
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Sogawa T, Hashida N, Sawa M, Nishida K. Rare Association of Perivascular Granulomatous Lesions in a Patient with Acute Retinal Necrosis. Case Rep Ophthalmol 2015; 6:373-9. [PMID: 26668578 PMCID: PMC4677696 DOI: 10.1159/000442084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to examine sequential changes in perivascular granulomatous lesions with acute retinal necrosis (ARN). Methods A healthy 46-year-old Japanese woman, who developed floaters and pain in her left eye, underwent optical coherence tomography (OCT), fluorescein angiography, and routine ophthalmological examinations. Treatment-associated changes in perivascular granulomatous lesions were monitored using spectral-domain (SD)-OCT. Results The patient had no previous ophthalmic history, and her general condition was good. A slit-lamp examination revealed keratic precipitates and aqueous cells (2+) in the left eye. A fundus examination showed yellow-white patches of necrotizing retinal lesions in the temporal upper area, retinal arteritis, retinal hemorrhage, and vitreous opacities. The patient was diagnosed with ARN according to diagnostic criteria. SD-OCT images confirmed high-intensity and uniform granulomatous deposits in the perivascular area and fovea. Systemic corticosteroids and antiviral therapy were initiated, resulting in the gradual resolution of granulomatous lesions. The patient continues to be followed untreated without evidence of recurrence, retinal detachment, or active inflammation. Conclusions This is the first report of perivascular granulomatous lesions in a patient with ARN. Our results showed that the formation of granulomas may be induced in the retina of ARN patients without fulminant inflammation.
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Affiliation(s)
- Takahiro Sogawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miki Sawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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Correspondence. Retina 2015; 36:e1. [PMID: 26579789 DOI: 10.1097/iae.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Nicholson L, Ramu J, Triantafyllopoulou I, Patrao NV, Comyn O, Hykin P, Sivaprasad S. Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy. Clin Exp Ophthalmol 2015; 43:735-41. [PMID: 25998983 DOI: 10.1111/ceo.12557] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disorganization of the retinal inner layers (DRIL) on optical coherence tomography (OCT) is thought to represent retinal capillary non-perfusion (CNP) in eyes with diabetic retinopathy. This study was designed to evaluate the ability of DRIL to accurately predict CNP. DESIGN Retrospective masked reliability and diagnostic accuracy study performed in the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre, London, UK SAMPLES: Retinal images of patients with diabetic retinopathy METHODS The OCT images from 90 separate areas of angiographically confirmed perfused and non-perfused areas of the macula from 37 eyes of 31 patients were anonymized and coded. Two masked graders independently graded these OCT scans for the presence or absence of DRIL to determine the intergrader reliability. The diagnostic accuracy of DRIL in identifying CNP was evaluated from the results obtained. MAIN OUTCOME MEASURES Sensitivity and specificity of DRIL in accurately detecting CNP RESULTS: The intergrader agreement was high with a Cohen's kappa of 0.909. DRIL was present in 84.4% (38/45) of non-perfused retina and none in perfused retina (0/45). The sensitivity and specificity of DRIL in detecting angiographic evidence of CNP was 84.4% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 86.5%. CONCLUSIONS The presence of DRIL is a reliable predictor of areas of macular CNP. However, DRIL is not a universal finding of non-perfusion, with some cases exhibiting absence of DRIL despite angiographic CNP.
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Affiliation(s)
- Luke Nicholson
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Jayashree Ramu
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | | | | | - Oliver Comyn
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Philip Hykin
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
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Ward TS, Reddy AK. Fundus autofluorescence in the diagnosis and monitoring of acute retinal necrosis. J Ophthalmic Inflamm Infect 2015; 5:19. [PMID: 26120371 PMCID: PMC4477008 DOI: 10.1186/s12348-015-0042-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Background Acute retinal necrosis (ARN), a vision threatening viral retinitis, is often diagnosed and treated based on clinical findings. These clinical features have been well characterized by various imaging modalities, but not using fundus autofluorescence (FAF), a noninvasive method of evaluating the neurosensory retina and retinal pigment epithelium (RPE) based on the detection of endogenous fluorophores. Findings A patient diagnosed with ARN was followed over a 10-month period to identify and document the fundus findings using FAF imaging. Pathological changes present at the level of the neurosensory retina and RPE in ARN can be detected and characterized using fundus autofluorescence imaging. Conclusions The borders of disease activity in ARN correlate with high-contrast changes in autofluorescence patterns to facilitate monitoring of disease progression.
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Affiliation(s)
- Tyson Sj Ward
- Department of Ophthalmology, University of Virginia, 1300 Jefferson Park Avenue, Charlottesville, VA 22901 USA
| | - Ashvini K Reddy
- Department of Ophthalmology, University of Virginia, 1300 Jefferson Park Avenue, Charlottesville, VA 22901 USA
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Ohtake-Matsumoto A, Keino H, Koto T, Okada AA. Spectral domain and swept source optical coherence tomography findings in acute retinal necrosis. Graefes Arch Clin Exp Ophthalmol 2015; 253:2049-51. [PMID: 26012421 DOI: 10.1007/s00417-015-3051-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Anna Ohtake-Matsumoto
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan, 181-8611
| | - Hiroshi Keino
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan, 181-8611
| | - Takashi Koto
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan, 181-8611
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan, 181-8611.
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Roy M. Optical coherence tomography in uveitis: the illumination of ocular inflammation. Can J Ophthalmol 2014; 49:1-4. [DOI: 10.1016/j.jcjo.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
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