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Sidiqi AM, Bhalla M, Khan HM, Chan F, Lowe C, Navajas EV. Treatment outcomes of PCR-positive acute retinal necrosis. Ir J Med Sci 2024; 193:509-516. [PMID: 37365446 DOI: 10.1007/s11845-023-03426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Acute retinal necrosis (ARN) is a progressive necrotizing retinitis caused by viral infection. Optimal management strategies have not been established for this detrimental disease. Previous literature published suggests that Varicella-zoster virus (VZV) and Herpes simplex virus-1 (HSV1) are the most common promoters of acute retinal necrosis (ARN). AIMS The purpose of our study was to investigate the viral distribution, demographic, and treatment outcomes of ARN. METHODS A retrospective chart review evaluated data from PCR-positive ARN patients diagnosed between 2009 and 2018. RESULTS Analysis of fourteen eyes from 12 patients found CMV and VZV as the commonest causes of ARN. Patients on 1 g of valacyclovir three times a day (V1T) had worse vision between first and final visits (mean difference of 1.25 ± 0.65, n = 2) compared with patients treated with 2 g of valacyclovir three times a day (V2T), or 900 mg twice a day of valganciclovir (V9B) (mean difference of - 0.067 ± 0.13, n = 6, and 0.067 ± 0.067, n = 6, respectively). Both V1T patients developed retinal detachments (RD). Both CMV patients treated with intravitreal triamcinolone developed ARN, elevated IOP, and one developed multiple RD. CONCLUSIONS Our review found increased incidence of CMV-positive ARN. Patients with zone 1 disease had worse initial visual acuity. Moreover, patients had more favorable outcomes with V2T and V9B compared to V1T. CMV-positive patients clinically worsened after intravitreal steroid injections, further underscoring the value of a PCR diagnosis to tailor the patients' treatment plan accordingly.
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Affiliation(s)
- Ahmad M Sidiqi
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mahadev Bhalla
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Haaris M Khan
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Forson Chan
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Lowe
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
| | - Eduardo V Navajas
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
- Eye Care Centre, Section C, 2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada.
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Putera I, Ridwan AS, Dewi M, Cifuentes-González C, Rojas-Carabali W, Sitompul R, Edwar L, Susiyanti M, Aziza Y, Pavesio C, Chee SP, Mahendradas P, Biswas J, Kempen JH, Gupta V, de-la-Torre A, La Distia Nora R, Agrawal R. Antiviral treatment for acute retinal necrosis: A systematic review and meta-analysis. Surv Ophthalmol 2024; 69:67-84. [PMID: 37774799 DOI: 10.1016/j.survophthal.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Acute retinal necrosis is a progressive intraocular inflammatory syndrome characterized by diffuse necrotizing retinitis that can lead to a poor visual outcome, mainly from retinal detachment. The antiviral treatment approach for acute retinal necrosis varies as there are no established guidelines. We summarize the outcomes of acute retinal necrosis with available antiviral treatments. Electronic searches were conducted in PubMed/MEDLINE, EMBASE, Scopus, and Google Scholar for interventional and observational studies. Meta-analysis was performed to evaluate the pooled proportion of the predefined selected outcomes. This study was registered in PROSPERO (CRD42022320987). Thirty-four studies with a total of 963 participants and 1,090 eyes were included in the final analysis. The estimated varicella-zoster virus and herpes simplex virus polymerase chain reaction-positive cases were 63% (95% CI: 55-71%) and 35% (95% CI: 28-42%), respectively. The 3 main antiviral treatment approaches identified were oral antivirals alone, intravenous antivirals alone, and a combination of systemic (oral or intravenous) and intravitreal antivirals. The overall pooled estimated proportions of visual acuity improvement, recurrence, and retinal detachment were 37% (95% CI: 27-47%), 14% (95% CI: 8-21%), and 43% (95% CI: 38-50%), respectively. Patients treated with systemic and intravitreal antivirals showed a trend towards better visual outcomes than those treated with systemic antivirals (oral or intravenous) alone, even though this analysis was not statistically significant (test for subgroup differences P = 0.83).
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Affiliation(s)
- Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Asri Salima Ridwan
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Metta Dewi
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia; Department of Bioinformatics, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ratna Sitompul
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Lukman Edwar
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Made Susiyanti
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Yulia Aziza
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK; UCL-Institute of Ophthalmology, London, UK
| | - Soon-Phaik Chee
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Singapore National Eye Centre, Singapore, Singapore
| | | | - Jyotirmay Biswas
- Department of Uvea and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute, Boston, Massachusetts, USA; Sight for Souls, Fort Myers, Florida, USA; Addis Ababa University Department of Ophthalmology, Addis Ababa, Ethiopia; MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rupesh Agrawal
- Department of Bioinformatics, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK; UCL-Institute of Ophthalmology, London, UK; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Singapore National Eye Centre, Singapore, Singapore; MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; Duke NUS Medical School, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore
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Shiezadeh E, Hosseini SM, Bakhtiari E, Mojarrad A, Motamed Shariati M. Clinical characteristics and management outcomes of acute retinal necrosis. Sci Rep 2023; 13:16927. [PMID: 37805622 PMCID: PMC10560224 DOI: 10.1038/s41598-023-44310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/06/2023] [Indexed: 10/09/2023] Open
Abstract
This study investigates patient's clinical characteristics and management outcomes of PCR-positive Acute Retinal Necrosis (ARN). The patient's clinical characteristics of the disease, and therapeutic approaches were assessed. Data from the medical records of 40 eyes of 40 patients were analyzed. The mean ± standard deviation (SD) of the age of the patients was 47.8 ± 14.1 years (16-84 years old). The median follow-up time was 160 days, with a range of 120-370 days. The mean ± SD of patients' primary and final BCVA was 1.24 ± 0.78 and 1.08 ± 0.86 LogMAR, respectively. The final BCVA increased significantly after the treatment in the last follow-up period in patients who did not undergo PPV (p = 0.029). Although, vision changes were not statistically significant in patients who underwent PPV (p = 0.549). 75% of our patients had a positive aqueous PCR for VZV, and the second most common causative agents were CMV and HSV (10% for each). Besides, rhegmatogenous retinal detachment (RRD) occurred in 25% of our patients. Our analysis showed that the presenting visual acuity and RRD occurrence are the significant prognostic factors for final blindness in ARN.
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Affiliation(s)
- Elham Shiezadeh
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Seyedeh Maryam Hosseini
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Elham Bakhtiari
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Alireza Mojarrad
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Mehrdad Motamed Shariati
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran.
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