1
|
Stolowy N, Comet A, Fardeau C, Beylerian M, Mabhiza O, Matonti F, Denis D. Choroidal hypoperfusion and diffuse retinal occlusive arteritis associated with varicella-zoster virus: A case report. J Fr Ophtalmol 2023; 46:e121-e125. [PMID: 36775732 DOI: 10.1016/j.jfo.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/22/2022] [Indexed: 02/12/2023]
Affiliation(s)
- N Stolowy
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - A Comet
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - C Fardeau
- Service d'ophtalmologie, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Beylerian
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - O Mabhiza
- Centre hospitalier de Salon de Provence: hôpital public, 207, avenue Julien-Fabre, 13300 Salon-de-Provence, France
| | - F Matonti
- Centre Monticelli-Paradis, 433 bis, rue Paradis, 13008 Marseille, France; Université Aix-Marseille, CNRS, INT, Institut de Neurosciences de la Timone, Marseille, France
| | - D Denis
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| |
Collapse
|
2
|
Sutra P, Pokawattana I. Retinal vasculopathy following varicella zoster virus infection. Curr Opin Ophthalmol 2022; 33:557-563. [PMID: 36165416 DOI: 10.1097/icu.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed. RECENT FINDINGS Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed. SUMMARY VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.
Collapse
Affiliation(s)
- Plern Sutra
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | |
Collapse
|
3
|
Gueudry J, Bodaghi B. Advances in the microbiological diagnosis of herpetic retinitis. FRONTIERS IN OPHTHALMOLOGY 2022; 2:990240. [PMID: 38983563 PMCID: PMC11182275 DOI: 10.3389/fopht.2022.990240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/24/2022] [Indexed: 07/11/2024]
Abstract
Viral retinitis associated with herpesvirus is one of the most severe forms of uveitis and is a potentially sight-threatening ophthalmologic disease. The prognosis is poor and a rapid and aggressive management is necessary to improve the visual and sometimes vital prognosis of these patients. The treatments used are not without side effects, while many differential diagnoses exist, such as toxoplasmic retinochoroiditis, syphilitic retinitis, endogenous endophthalmitis and intraocular lymphoma. Causatives viruses are herpes simplex virus, varicella-zoster virus, and cytomegalovirus, which require rapid detection in ocular fluid, mainly aqueous humor. However, only a small amount of intraocular fluid is available for analysis. Advances in microbiological diagnostic techniques therefore were key factors in improving the management of these diseases. Historically, the diagnosis was based on immunological tests but more recently advances in molecular biology, in particular polymerase chain reaction, have played a crucial role to obtain a reliable and rapid diagnosis of viral retinitis associated with herpesvirus, as discussed in this review.
Collapse
Affiliation(s)
- Julie Gueudry
- Department of Ophthalmology - Charles Nicolle University Hospital, CHU Charles Nicolle, Rouen, France
| | - Bahram Bodaghi
- Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Pitié Salpêtrière Hospital, Paris, France
| |
Collapse
|
4
|
Maher DI, Lee JT, Lin ML, Hall AJ. Painless Loss of Vision and a Vesicular Rash in a 22-Year-Old. Clin Infect Dis 2022; 74:1703-1705. [PMID: 35511801 DOI: 10.1093/cid/ciab666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dominic I Maher
- Department of Ophthalmology, The Alfred Hospital, Melbourne,Australia
| | - Jonathan T Lee
- Department of Ophthalmology, The Alfred Hospital, Melbourne,Australia.,Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Ming-Lee Lin
- Department of Ophthalmology, The Alfred Hospital, Melbourne,Australia.,Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Anthony J Hall
- Department of Ophthalmology, The Alfred Hospital, Melbourne,Australia.,Department of Surgery, Monash Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| |
Collapse
|
5
|
Varicella Retinal Vasculopathy: Unilateral Cilioretinal Artery Occlusion Despite Acyclovir Therapy Caught Using Optical Coherence Tomography-Angiography (OCTA). Case Rep Ophthalmol Med 2019; 2019:5752180. [PMID: 31380132 PMCID: PMC6662444 DOI: 10.1155/2019/5752180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
Varicella zoster is known to be associated with vaso-occlusive pathologies, vasculitis, or optic neuritis, leading to profound visual loss. We report a case where a 13-year-old boy who initially presented to us with on and off diminution of vision in his right eye since 3 days and had normal ocular and OCT angiography findings followed up in 5 days with sudden painless diminution of vision in the same eye since one day this time revealing a pale macular region with rest of the retina being normal. Repeated OCT angiography showed loss of the capillary network around the perifoveal region suggesting cilioretinal artery occlusion.
Collapse
|
6
|
|
7
|
ADULT WITH CHICKENPOX COMPLICATED BY SYSTEMIC VASCULITIS AND BILATERAL RETINAL VASCULITIS WITH RETINAL VASCULAR OCCLUSIONS. Retin Cases Brief Rep 2016; 11:364-368. [PMID: 27533640 DOI: 10.1097/icb.0000000000000372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe an adult with chickenpox resulting in systemic vasculitis and bilateral retinal vascular occlusions. METHODS Single case report. RESULTS A 58-year-old man with chickenpox complicated by disseminated varicella-zoster systemic and retinal vasculitis resulting in a combined arterial and venous occlusion in one eye with multiple branch retinal vein occlusions in the other eye. There was no evidence of retinitis. The patient systemically improved after treatment with acyclovir and steroids; however, his vision remained poor. CONCLUSION Chickenpox can be associated with systemic vasculopathy and may rarely result in multiple systemic and ocular infarcts, including severe retinal vascular occlusions.
Collapse
|
8
|
Hyun SY, Kim DY, Chae JB. Multiple Serous Chorioretinopathy after Facial Herpes Zoster. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.1.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yoon Hyun
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| |
Collapse
|
9
|
Narayanan S, Gopalakrishnan M, Giridhar A, Anthony E. Varicella Zoster-related Occlusive Retinal Vasculopathy--A Rare Presentation. Ocul Immunol Inflamm 2014; 24:227-30. [PMID: 25084211 DOI: 10.3109/09273948.2014.938759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report a case of occlusive retinal vasculopathy following varicella zoster infection in an immunocompetent adult. DESIGN Observational case report. METHODS A patient with defective vision following chickenpox was evaluated with fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence. RESULTS Fundus showed multiple cotton wool spots and a well-demarcated zone of retinal ischemia in the posterior pole with normal optic disc without any evidence of anterior or posterior uveitis. Fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence findings revealed occlusive vasculopathy as the cause of defective vision. CONCLUSIONS We report a hitherto undescribed case of purely occlusive vasculopathy following varicella zoster infection without features of vasculitis or anterior and posterior uveitis in an immunocompetent individual.
Collapse
Affiliation(s)
- Sandhya Narayanan
- a Department of Uvea , Giridhar Eye Institute , Kadavanthra , Cochin , India
| | | | | | - Eliza Anthony
- a Department of Uvea , Giridhar Eye Institute , Kadavanthra , Cochin , India
| |
Collapse
|
10
|
Kahloun R, Mbarek S, Khairallah-Ksiaa I, Jelliti B, Yahia SB, Khairallah M. Branch retinal artery occlusion associated with posterior uveitis. J Ophthalmic Inflamm Infect 2013; 3:16. [PMID: 23514435 PMCID: PMC3605076 DOI: 10.1186/1869-5760-3-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to report the clinical features and visual outcome of branch retinal artery occlusion (BRAO) associated with posterior uveitis. This is a retrospective study including the 18 eyes of 18 patients. All patients underwent a complete ophthalmic evaluation. Fundus photography, fluorescein angiography, and visual field testing were performed in all cases. RESULTS Diseases associated with BRAO included active ocular toxoplasmosis in 7 patients, rickettsiosis in 4, Behçet's uveitis in 2, West Nile virus infection in 1, idiopathic retinal vasculitis in 1, Crohn's disease in 1, ocular tuberculosis in 1, and idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome in 1 patient. The mean initial visual acuity was 20/50. BRAO involved the first order retinal artery in 33.3% of the eyes, the second order retinal artery in 33.3%, an arteriole in 27.8%, and a cilioretinal artery in 5.5%. The macula was involved in 44.4% of the eyes and an acute focus of retinitis or retinochoroiditis was associated to BRAO in 55.5%. Repermeabilization of the occluded artery occurred in all patients with permanent scotomas in the corresponding visual field. The mean visual acuity at last visit was 20/32. CONCLUSIONS BRAO, with subsequent visual impairment, may occur in the eyes with posterior uveitis. Physicians should be aware of such vision-threatening complication of infectious and inflammatory eye diseases.
Collapse
Affiliation(s)
- Rim Kahloun
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir 5019, Tunisia.
| | | | | | | | | | | |
Collapse
|
11
|
Camuglia JE, Beltz JE, Khurana K, Hall AJ. An unusual cause of visual loss after Herpes zoster ophthalmicus: a case report. CASES JOURNAL 2010; 3:17. [PMID: 20180950 PMCID: PMC2829517 DOI: 10.1186/1757-1626-3-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/12/2010] [Indexed: 11/10/2022]
Abstract
Introduction The vascular complications of herpes zoster are well recognised, however, there are few reports of central retinal artery occlusion. Central retinal artery occlusion following herpes zoster ophthalmicus is poorly recognised. This is likely due to the difficulties in obtaining tissue for histopathology to establish causality. We report a case of central retinal artery occlusion and complete internal carotid artery occlusion following herpes zoster ophthalmicus. Case presentation A 44 year old Caucasian female presented with sudden painless loss of vision in her right eye on a background of chronic lymphocytic leukaemia and right sided herpes zoster ophthalmicus. She was initially treated with steroids and antivirals for an underlying presumed vasculitic cause, but review at 24 hours demonstrated a right central retinal artery occlusion. Embolic screen identified complete occlusion of the right internal carotid artery. She was treated with oral antiviral medication for three weeks but had no visual recovery. Conclusion This case highlights an uncommon cause of acute visual loss. We propose that the underlying small and large vessel occlusion in this patient was due to herpes zoster related vasculopathy. A review of the literature is presented to trace the historical perspective of herpes zoster related vasculopathy.
Collapse
Affiliation(s)
- Jayne E Camuglia
- Department of Ophthalmology, The Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria 3004, Australia.
| | | | | | | |
Collapse
|
12
|
Wickremasinghe SS, Stawell R, Lim L, Pakrou N, Zamir E. Non-necrotizing herpetic vasculitis. Ophthalmology 2009; 116:361. [PMID: 19187825 DOI: 10.1016/j.ophtha.2008.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022] Open
|
13
|
Affiliation(s)
- Ehud Zamir
- Ocular Immunology Service, The Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia
| |
Collapse
|
14
|
Abstract
The diagnosis of necrotic herpetic retinitis is suggested on clinical grounds, prompting urgent appropriate intravenous and intravitreal treatment. PCR on ocular samples is most often successful in identifying the herpetic agent. Classic acute retinal necrosis syndrome caused by herpes simplex or zoster virus and the different clinical forms present in immunocompetent or immunodepressed patients are described. The differential diagnosis includes atypical presentation of retinal necrosis caused by toxoplasmosis, syphilis, or ocular lymphoma; the ocular samples are useful in establishing the etiological diagnosis. We describe the different therapeutic strategies in the acute phase and as secondary prophylactic treatment. The clinical outcome appears to be influenced by rapid, appropriate treatment, limiting the extension of the retinal necrosis.
Collapse
Affiliation(s)
- C Fardeau
- Service d'Ophtalmologie, Hôpital Pitié-Salpétrière, 91, boulevard de l'Hôpital, 75013 Paris
| |
Collapse
|
15
|
Abstract
The viral retinitis are linked to infection by herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV). When the diagnosis is clinically suspected the antiviral treatment has to be introduced immediately after performing the ocular sampling to try to identify the infectious agent. Despite the various antiherpetic drugs available by intravenous routes and intravitreal injection, the prognostic of the herpetic retinitis remained severe because of the occurrence of retinal detachment, optic neuritis, macular necrosis. Various clinical forms are described: (1) the classical "acute necrotizing retinitis" (2) a form with a slow progression of the necrotizing retinitis (3) occlusive retinal arteritis (4) the highly severe "progressive retinal necrosis". The incidence of the CMV retinitis diminished with the highly antiretroviral therapy; however uveitis may occur with no active CMV retinitis. The various antiherpetic drugs are described with special indications.
Collapse
Affiliation(s)
- C Fardeau
- Service d'ophtalmologie, Hôpital Pitié-Salpêtrière, Paris, France.
| | | | | |
Collapse
|
16
|
Ostermann ME, Gyawali P, Snowden SA, Eastwood JB, Streather CP. A 67-year-old kidney transplant patient with headache of uncertain origin. Nephrol Dial Transplant 2002; 17:508-10. [PMID: 11865103 DOI: 10.1093/ndt/17.3.508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Affiliation(s)
- H Moriuchi
- Department of Infectious Diseases, Children's National Medical Center, Washington, DC, USA.
| | | |
Collapse
|
18
|
Elnifro EM, Cooper RJ, Klapper PE, Bailey AS, Tullo AB. Diagnosis of viral and chlamydial keratoconjunctivitis: which laboratory test? Br J Ophthalmol 1999; 83:622-7. [PMID: 10216067 PMCID: PMC1723048 DOI: 10.1136/bjo.83.5.622] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- E M Elnifro
- Division of Virology, Department of Pathological Sciences, University of Manchester
| | | | | | | | | |
Collapse
|