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Thawley J, Colbert C, Eilbert W. Acute retinal necrosis: A case report. Am J Emerg Med 2024:S0735-6757(24)00248-1. [PMID: 38806298 DOI: 10.1016/j.ajem.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
Acute retinal necrosis (ARN) is a rare, progressive viral uveitis, with the majority of cases caused by herpesviruses. The diagnosis of ARN is often delayed, and most patients will have some degree of permanent visual loss. We report a case of ARN in a previously healthy 32-year-old patient.
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Affiliation(s)
- Jessica Thawley
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469 COME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
| | - Christopher Colbert
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469 COME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469 COME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
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2
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Kalogeropoulos D, Afshar F, Kalogeropoulos C, Vartholomatos G, Lotery AJ. Diagnostic and therapeutic challenges in acute retinal necrosis; an update. Eye (Lond) 2024:10.1038/s41433-024-03028-x. [PMID: 38519714 DOI: 10.1038/s41433-024-03028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Acute retinal necrosis (ARN) is a rare but severe ophthalmic pathology defined by panuveitis, retinal necrosis, and high rates of retinal detachment. ARN may lead to poor visual outcomes even if promptly diagnosed and treated. ARN may present with a wide spectrum of clinical findings compatible with panuveitis including anterior uveitis, scleritis, vitritis, necrotizing retinitis, occlusive vasculitis, and optic disc edema. The American Uveitis Society introduced clinical criteria in 1994 for the diagnosis of ARN, while more recent criteria have been proposed by the Standardization of Uveitis Nomenclature (SUN) Working Group and the Japanese ARN Study Group. Multimodal imaging is a valuable tool in evaluating patients with ARN, particularly in unusual cases, while utilizing retinal imaging and applying AI algorithms in these areas of clinical research could be highly beneficial. Over the last few years, significant progress has been made in achieving timely diagnosis and treatment. The precise identification of the viral cause in suspected ARN cases has been greatly enhanced by the advancements in PCR techniques and flow cytometry used for intraocular fluids. systemic (intravenous or oral) antivirals with adjunctive intravitreal antiviral therapy are recommended as first-line therapy to reduce disease severity, the risk of vision loss, and retinal detachment incidence. Although aciclovir was the first existing antiviral agent, at present many clinicians prefer high-dose valaciclovir orally or intravenous aciclovir combined with intravitreal foscarnet. Despite significant progress in diagnosing and treating ARN, further research is needed to improve visual outcomes in this challenging clinical condition.
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Affiliation(s)
| | - Farid Afshar
- Southampton Eye Unit, University Hospital Southampton, Southampton, UK
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Southampton, UK.
- Faculty of Medicine, University of Southampton, Southampton, UK.
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3
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Akhavanrezayat A, Uludag Kirimli G, Matsumiya W, Khojasteh H, Or C, Karaca I, Pham B, Ongpalakorn P, Lajevardi S, Lam B, Hwang JJ, Than NTT, Park S, Yavari N, Bazojoo V, Mobasserian A, Khatri A, Halim MS, Thng ZX, Ghoraba H, Do DV, Tugal-Tutkun I, Gupta V, de Smet M, Nguyen QD. The Role of Corticosteroids and Immunomodulatory Therapy in the Management of Infectious Uveitis. Ocul Immunol Inflamm 2024:1-12. [PMID: 38330155 DOI: 10.1080/09273948.2023.2296032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The index review aims to provide an update on the role of corticosteroids and steroid-sparing immunomodulatory therapy (IMT) in managing patients with infectious uveitis. METHOD Narrative literature review. RESULTS Corticosteroids and immunomodulatory therapy (IMT) focus on the host defense system instead of the pathogen, adjusting exaggerated inflammatory reactions to reduce potential harm to ocular tissues. Systemic or local corticosteroids are primarily selected as adjunctive medication for infectious uveitis. Concomitant corticosteroids have also been used in cases of paradoxical worsening in ocular tuberculosis and immune recovery uveitis in cytomegalovirus (CMV) retinitis. While there is no well-established evidence to support the use of IMT in infectious uveitis, it is occasionally used in clinical settings to treat persistent inflammation following resolution of infection such as cases of ocular tuberculosis and ocular syphilis where an insufficient response is observed with corticosteroids. CONCLUSION There is no consensus on the position of immunomodulatory therapy in the management of infectious uveitis with different etiologies. The index review provides an overview of available adjunctive corticosteroids and IMT options to assist clinicians in managing such disease entities more efficiently.
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Affiliation(s)
- Amir Akhavanrezayat
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gunay Uludag Kirimli
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Wataru Matsumiya
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hassan Khojasteh
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Christopher Or
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Irmak Karaca
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Brandon Pham
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Sherin Lajevardi
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Brandon Lam
- Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jaclyn Joyce Hwang
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ngoc Trong Tuong Than
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - SungWho Park
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Negin Yavari
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vahid Bazojoo
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Azadeh Mobasserian
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Zheng Xian Thng
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hashem Ghoraba
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Bayrampasa Eye Hospital, Eye Protection Foundation, Istanbul, Turkey
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc de Smet
- Department of Ophthalmology, MicroInvasive Ocular Surgery Clinic (MIOS), Lausanne, Switzerland
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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4
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Rangel CM, Restrepo-Arango M, Mejía-Salgado G, Gómez-Rocha MA, Gómez Velasco M, García MF, Moreno JJ. Acute Retinal Necrosis: Experience in a Reference Center in Santander - Colombia. Ocul Immunol Inflamm 2023:1-9. [PMID: 37582226 DOI: 10.1080/09273948.2023.2244076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes. OBJECTIVE We present an ARN case series showcasing treatment experience and results. METHODOLOGY Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging. RESULTS Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity. CONCLUSIONS Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis. ABBREVIATIONS ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: Toxoplasma gondii; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.
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Affiliation(s)
- Carlos Mario Rangel
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | | | - Germán Mejía-Salgado
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - María Alejandra Gómez-Rocha
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Maira Gómez Velasco
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - María Fernanda García
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Juan José Moreno
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
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Yang Y, Zhang W, Li Y. Acute Retinal Necrosis Possibly Triggered by Contra-Lateral Penetrating Trauma. Ocul Immunol Inflamm 2023:1-4. [PMID: 37364248 DOI: 10.1080/09273948.2023.2228401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Acute retinal necrosis is a rare but devastating acute posterior uveitis caused by a member of the herpes virus family. We report an extremely rare ARN case following penetrating trauma in the contralateral eye. CASE PRESENTATION A 61-year-old male was misdiagnosed as sympathetic ophthalmia due to a penetrating trauma history of the contralateral eye. The subsequent administration of high-dose IVMP therapy led to rapid progression of the retinal necrosis. ARN was strongly suspected base on the clinical examination and confirmed by the PCR aqueous testing. The patient finally got good visual outcomes by the effective and prompt antiviral treatment. CONCLUSION Ophthalmologists should be alert to the possibility that penetrating injury can trigger the activation of latent viruses. If a patient experiences visual symptoms in the contralateral eye after an open-globe injury, it is recommended that a thorough peripheral retinal examination be performed to avoid missing ARN.
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Affiliation(s)
- Yi Yang
- Department of Ophthalmology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, P. R. China
| | - Wenfang Zhang
- Department of Ophthalmology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, P. R. China
| | - Yuting Li
- Department of Ophthalmology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, P. R. China
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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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Arevalo JF, Beatson B. Surgery for Infectious Retinitis - When Medical Therapy Is Not Sufficient: The Moacyr E. Alvaro Pan-American Lecture 2023. Ocul Immunol Inflamm 2023:1-9. [PMID: 36758250 DOI: 10.1080/09273948.2023.2174883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Viral retinitis composes a group of infectious ocular diseases with poor prognoses. With the advent of antivirals and HAART, the treatment of these diseases has evolved and ocular outcomes have improved. However, even with prompt medical treatment, a significant number of patients will experience complications that require surgical intervention. While there has been an abundance of research examining the medical treatment of CMV retinitis and acute retinal necrosis, the research examining surgical outcomes of complications such as retinitis-associated retinal detachment is comparatively limited. METHODS Literature review. RESULTS In this review, we discuss the current literature examining treatment of CMV retinitis and acute retinal necrosis, with a focus on surgical management of complications such as retinal detachment. CONCLUSIONS Despite significant improvements in the medical treatment of CMV retinitis and ARN over the last three decades, vision-threatening complications such as retinal detachment are relatively common and require surgical management via PPV, laser photocoagulation, and intraocular gas or silicone oil tamponade.
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Affiliation(s)
- J Fernando Arevalo
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Bradley Beatson
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
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8
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Mitkova-Hristova V, Stoyanova NS. Acute retinal necrosis: pathophysiological aspects, diagnosis, and treatment. Folia Med (Plovdiv) 2022; 64:871-877. [PMID: 36876564 DOI: 10.3897/folmed.64.e68036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 01/01/2023] Open
Abstract
Acute retinal necrosis (ARN) is a devastating viral infection commonly associated with varicella zoster virus (VZV) and herpes simplex virus types 1 and 2 (HSV-1, HSV-2). Typically, ARN affects individuals without immune status disorders between the ages of 50-70. In two-thirds of the cases, one-eye involvement is observed and the inflammation can be presented as panuveitis. The most characteristic clinical manifestations are vitreitis, occlusion of the retinal arterioles, and peripheral necrotizing retinitis. Retinitis presents with the appearance of deep, multifocal, yellowish-white foci, typically localized in the peripheral retina. Systemic antivirals are the first treatment of choice for ARN. The goal of the therapy is to stop the viral replication and disease progression in the affected eye, as well as to prevent involvement of the healthy eye. The other eye can be attacked in an interval of 5 days to 30 years. The visual prognosis after illness is poor. Early diagnosis and timely initiation of treatment play an important role in maintaining visual acuity and preventing the other eye from being affected.
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Affiliation(s)
| | - Nina S Stoyanova
- University Eye Clinic, St George University Hospital, Plovdiv, Bulgaria
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Sørland RØ, Erichsen AK, Jonsdottir TE, Bromnes MN, Lauritzen PM, Eidet JR. Successful treatment with repeated dexamethasone implant injections for recurrent macular edema after acute retinal necrosis. J Ophthalmic Inflamm Infect 2022; 12:33. [PMID: 36269441 PMCID: PMC9587196 DOI: 10.1186/s12348-022-00310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background The treatment of recurrent cystoid macular edema associated with acute retinal necrosis is challenging due to the concern that treatment with intravitreal steroids may reactivate the retinitis. Case report An immunocompetent patient diagnosed with acute retinal necrosis was treated with oral valacyclovir and intravitreal injections of foscarnet. Giant tears in her retina necessitated a vitrectomy with silicone oil. She developed cystoid macular edema after the removal of the silicone oil. The edema responded to high-dose prednisolone but recurred when the dose was tapered to 20 mg daily. Under close surveillance and increased antiviral medication, she was treated with a dexamethasone implant with complete resolution of the edema. Unfortunately, the edema recurred, and the treatment had to be repeated. Over 18 months, she received five dexamethasone implants without recurrence of the viral retinitis. Conclusions This case shows successful treatment of recurring cystoid macular edema following acute retinal necrosis with repeated intravitreal dexamethasone implants in a patient receiving valacyclovir maintenance treatment.
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Affiliation(s)
| | | | | | | | | | - Jon Roger Eidet
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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10
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Hung JH, Rao NA, Chiu WC, Sheu SJ. Vitreoretinal surgery in the management of infectious and non-infectious uveitis - a narrative review. Graefes Arch Clin Exp Ophthalmol 2022; 261:913-923. [PMID: 36220982 DOI: 10.1007/s00417-022-05862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/09/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to conduct a narrative review about the current role of vitreoretinal surgery in the management of infectious and non-infectious uveitis. METHODS This review was performed based on a search of the PubMed database or on relevant published papers according to our current knowledge. RESULTS A total of 91 articles were identified in the literature review. With the advance of microincision vitrectomy surgery (MIVS), pars plana vitrectomy (PPV) has gained increasing popularity in the management of infectious and non-infectious uveitis. For diagnostic purposes, larger amounts of sample can be obtained by MIVS than traditional vitreous aspiration using needles. For treatment purposes, PPV removes vitreous opacities, decreases inflammatory cytokines and mediators of inflammation, and tackles related complications, including hypotony, epiretinal membrane, macular holes, and retinal detachment. Achieving optimum control of inflammation prior to surgery is important for surgical interventions for non-emergent therapeutic indications and complications of uveitis. Peri-operative inflammation management is essential for decreasing the risk of surgical intervention. An overall complication rate of 42-54% was reported with cataract to be the leading cause of complications. CONCLUSION Most reports affirm the role of PPV in the management of infectious and non-infectious uveitis, although the quality of data remains limited by a lack of applying standardized reporting outcomes, limitations in study design, and a paucity of prospective data.
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Affiliation(s)
- Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Narsing A Rao
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Wei-Chun Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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11
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Mojarrad A, Omidtabrizi A, Ansari Astaneh M, Bakhtiari E, Shiezadeh E, Hassani M, Hosseini SM. Acute retinal necrosis. Management and visual outcomes: a case series. Int J Retina Vitreous 2022; 8:66. [PMID: 36109794 PMCID: PMC9476592 DOI: 10.1186/s40942-022-00417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The present study reports the functional and anatomical outcomes of eyes with acute retinal necrosis(ARN).
Methods
This is a retrospective case series conducted at a tertiary Eye Hospital from March 2015 to March 2020. Medical records of patients with clinical and laboratorial—Polymerase Chain Reaction (PCR)—diagnosis of ARN were reviewed. To identify factors related to the outcomes of visual acuity(VA) and retinal detachment (RD) over time, Cox proportional hazards regression modeling and survival analyses were used.
Results
Twenty-three eyes of 23 patients (16 male, 7 female) were reviewed. Based on the PCR results, 16 cases (69.6%) had Varicella zoster virus, 3 cases (13%) had Cytomegalovirus, 1 patient (4.3%) had Herpes simplex virus associated ARN, and 1 case (4.3%) had negative PCR. The incident rate for ≥ 2-line VA gain was 0.28/eye-year (EY) (95% CI 0.21 ± 0.26) while the rate of severe vision loss was 0.09/eye-year (95% CI 0.05 ± 0.08). The RD development was observed at a rate of 0.43/eye-year (0.42 ± 0.02), which occurred in 9 eyes with a mean time of 100 days after the initial presentation of ARN. Patients’ age was the only factor associated with 2-line or more gain in VA over time with a hazard ratio of 0.921 (95% CI 0.854–0.993, P = 0.032).
Conclusions
Generally, although being crucial, treatment is not highly effective in improvement of VA and decrease of RD development, as well as vision loss, in patients with ARN. However, treatment prevents fellow eye involvement efficiently. Younger age is associated with better response to treatment and more chance to achieve better VA.
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12
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Zhou A, Ong SS, Ahmed I, Arevalo JF, Cai CX, Handa JT. Socioeconomic disadvantage and impact on visual outcomes in patients with viral retinitis and retinal detachment. J Ophthalmic Inflamm Infect 2022; 12:26. [PMID: 35916989 PMCID: PMC9346012 DOI: 10.1186/s12348-022-00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
While socioeconomic disparities impact clinical care and patient outcomes, their impact on the anatomic and visual outcomes of retinal detachment in patients with viral retinitis is unstudied. This case series included 18 eyes in 18 patients from a single academic institution between January 1, 2008 and December 31, 2018. Patient characteristics including age, sex, race, ethnicity, insurance, immunosuppression, viral retinitis, retinal detachment, retinal detachment repair, visual and anatomic outcomes, missed appointments, and Area Deprivation Index [ADI] were collected. The low-ADI group, indicating less socioeconomic disadvantage, was comprised of twelve patients with national ADIs less than 38, and the high-ADI group of six patients with national ADIs greater than 38. High-ADI patients tended to be younger (average age 38.0 versus 51.3; P = 0.06), of female sex (P = 0.03), and had more missed appointments (median 11.0 vs 0; P = 0.002). A similar number of patients in both the high-ADI and low-ADI groups underwent pars plana vitrectomy alone or pars plana vitrectomy with scleral buckle. Visual acuity was similar in the high-ADI group than in the low-ADI group at baseline, but worse at the final follow-up visit (P = 0.004). Post-operative and final visit ocular hypotony were more common in the high-ADI group (P = 0.02). In our series, socioeconomic disadvantage negatively affects the visual outcomes in patients with viral retinitis associated-retinal detachments. These factors should be considered by ophthalmologists when treating these patients.
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Affiliation(s)
- Ashley Zhou
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sally S Ong
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ishrat Ahmed
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Abstract
SIGNIFICANCE Acute retinal necrosis is a rare, sight-threatening condition typically found in immunocompromised patients and is most commonly caused by varicella zoster virus. Due to the poor prognosis and rapid progression of the disease course, prompt antiviral management is paramount. PURPOSE A case report of acute retinal necrosis in a patient with herpes virus infection following a cervical epidural corticosteroid injection. Extensive laboratory work and frequent follow-ups are necessary for management. This case report outlines the clinical signs of acute retinal necrosis and discusses the appropriate referrals and treatment needed to improve prognosis. CASE REPORT A 63-year-old man presented to our eye clinic with symptoms of pain and light sensitivity. Examination revealed anterior uveitis, vitritis, optic disc edema, macular edema, vasculitis, and retinitis of the left eye. The serum antibody test results showed abnormal ranges for varicella zoster virus and herpes simplex virus type 1, and the patient was diagnosed with acute retinal necrosis. Treatment prescribed by a retina specialist included oral valacyclovir and later oral prednisolone, for which the patient responded well before developing the common complication of retinal detachment. CONCLUSIONS The progressive nature of acute retinal necrosis is usually debilitating to vision, even when managed properly. Because prognosis is often poor, it is important to make proper diagnoses combined with a complete review of the patient's medical history and immune status to prevent further vision loss.
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Kiraly P, Groznik AL, Valentinčič NV, Mekjavić PJ, Urbančič M, Ocvirk J, Mesti T. Choroidal thickening with serous retinal detachment in BRAF/MEK inhibitor-induced uveitis: A case report. World J Clin Cases 2022; 10:6536-6542. [PMID: 35979276 PMCID: PMC9294905 DOI: 10.12998/wjcc.v10.i19.6536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/19/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have revolutionized the treatment of patients with unresectable metastatic malignant melanoma. In addition to systemic side effects, several usually mild ocular adverse effects have been reported. We report a case of rarely reported vision-threatening bilateral panuveitis with serous retinal detachment, thickened choroid, and chorioretinal folds associated with dabrafenib and trametinib targeted therapy for B-Raf proto-oncogene serine/threonine kinase (BRAF) mutant metastatic cutaneous melanoma.
CASE SUMMARY A 59-year-old female patient with metastatic melanoma treated with dabrafenib and trametinib presented with blurry vision and central scotoma lasting for 3 d in both eyes. Clinical examination and multimodal imaging revealed inflammatory cells in the anterior chamber, mild vitritis, bullous multiple serous retinal detachments, and chorioretinal folds in both eyes. Treatment with dabrafenib and trametinib was suspended, and the patient was treated with topical and intravenous corticosteroids followed by oral corticosteroid treatment with a tapering schedule. One and a half months after the disease onset, ocular morphological and functional improvement was noted. Due to the metastatic melanoma dissemination, BRAF/mitogen-activated protein kinase inhibitors were reintroduced and some mild ocular adverse effects reappeared, which later subsided after receiving oral corticosteroids.
CONCLUSION Patients on combination therapy with dabrafenib and trametinib may rarely develop severe bilateral panuveitis with a good prognosis. Further studies have to establish potential usefulness of ophthalmological examination for asymptomatic patients. Furthermore, appropriate guidelines for managing panuveitis associated with dabrafenib and trametinib should be established.
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Affiliation(s)
- Peter Kiraly
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, SI-1000 Ljubljana, Slovenia
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, United Kingdom
| | - Alenka Lavrič Groznik
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, SI-1000 Ljubljana, Slovenia
| | | | - Polona Jaki Mekjavić
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, SI-1000 Ljubljana, Slovenia
| | - Mojca Urbančič
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, SI-1000 Ljubljana, Slovenia
| | - Janja Ocvirk
- Department of Medical Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Tanja Mesti
- Department of Medical Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
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Lains I, Eliott D. Challenges and Updates on the Management of Acute Retinal Necrosis. Int Ophthalmol Clin 2022; 62:173-196. [PMID: 35325918 DOI: 10.1097/iio.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheraqpour K, Ahmadraji A, Rashidinia A, Irannejad M, Shahriari M. Acute retinal necrosis caused by co-infection with multiple viruses in a natalizumab-treated patient: a case report and brief review of literature. BMC Ophthalmol 2021; 21:337. [PMID: 34530769 PMCID: PMC8447524 DOI: 10.1186/s12886-021-02096-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
Background Acute retinal necrosis is considered a rare infectious uveitis. This condition is usually caused by varicella-zoster virus or herpes simplex virus. Acute retinal necrosis caused by co-infection with multiple viruses is extremely rare. Herein, we report a case of acute retinal necrosis caused by co-infection with herpes simplex virus (type I and II) and varicella-zoster virus (VZV) in a natalizumab-treated patient due to multiple sclerosis. Case presentation An adult man presented with a complaint of decreased vision of the right eye from 12 days ago. He was a known case of multiple sclerosis receiving natalizumab. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3 + anterior chamber and vitreous cells, elevated intraocular pressure (26 mmHg), a blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches in the peripheral retina compatible with diagnosis of acute retinal necrosis. He underwent anterior chamber and vitreous tap, and real-time PCR detected HSV I & II and VZV on the vitreous specimen. A second PCR showed the same result. After neurological consultation, natalizumab was discontinued and intravenous acyclovir was started followed by oral acyclovir and oral prednisolone to control the disease, which was successful. Conclusions Although rare, multiple-viral infection should be considered in the physiopathology of acute retinal necrosis, especially in immunosuppressed patients.
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Affiliation(s)
- Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, 1336616351, Tehran, Iran
| | - Aliasghar Ahmadraji
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, 1336616351, Tehran, Iran.
| | - Ali Rashidinia
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, 1336616351, Tehran, Iran
| | - Maziyar Irannejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, 1336616351, Tehran, Iran
| | - Mansoor Shahriari
- Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kumar A, Narde HK. Commentary: Pars plana vitrectomy for acute retinal necrosis related rhegmatogenous retinal detachment. Indian J Ophthalmol 2021; 69:640-641. [PMID: 33595492 PMCID: PMC7942077 DOI: 10.4103/ijo.ijo_2685_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Atul Kumar
- Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Harpreet K Narde
- Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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