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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; 32:1832-1843. [PMID: 38330155 DOI: 10.1080/09273948.2023.2296032] [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: 08/09/2023] [Revised: 11/24/2023] [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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2
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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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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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4
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Acute retinal necrosis: clinical features, management and outcomes. Int Ophthalmol 2022; 43:1987-1994. [DOI: 10.1007/s10792-022-02598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/12/2022] [Indexed: 11/28/2022]
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Clinical and Virological Characteristics and Prognostic Factors in Viral Necrotizing Retinitis. J Pers Med 2022; 12:jpm12111785. [PMID: 36579507 PMCID: PMC9695359 DOI: 10.3390/jpm12111785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/19/2022] [Accepted: 10/15/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose: Describe the clinical and virological characteristics of viral necrotizing retinitis (VNR) and assess its prognostic factors. Methods: Retrospective study (Pitié Salpêtrière Hospital, Paris) of consecutive VNR patients diagnosed and monitored by qPCR on aqueous humor between 2015 and 2019. All patients received induction therapy with intravenous +/− intravitreal injections (IVI) of antivirals. Results: Forty-one eyes of 37 patients with a mean age of 56 years were included. Involved viruses were VZV (44%), CMV (37%) and HSV2 (19%). Acute retinal necrosis represented 51%, progressive outer retinal necrosis 12% and CMV retinitis 37% of eyes. Forty-six percent of patients were immunocompromised. Median BCVA was 0.7 LogMAR at baseline and 0.8 LogMAR after an average of 14.1 months. VNR bilateralized in 27% of cases after 32 months. Retinal detachment (RD) occurred in 27% of cases after a mean duration of 98 days. Factors associated with a “poor BCVA” at 1 month were: advanced age, low baseline BCVA, high vitritis grade and viral load (VL) at baseline and the “slow responder” status (i.e., VL decrease <50% after 2 weeks of treatment). Factors associated with RD were: advanced age, immunocompetence, low baseline BCVA, high vitritis grade at baseline and use of ≤5 IVIs. Conclusions: Clinical factors including advanced age, immunocompetence, low BCVA and high vitritis grade at baseline were associated with a poor prognosis. New virological factors were predictive of a poor outcome: high baseline VL and the “slow responder” status. Sequential intraocular fluid sampling might help prognosticate the outcomes of VNR.
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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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7
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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
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8
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Acute Retinal Necrosis: Virological Features Using Quantitative Polymerase Chain Reaction, Therapeutic Management, and Clinical Outcomes. Am J Ophthalmol 2019; 208:376-386. [PMID: 31449790 DOI: 10.1016/j.ajo.2019.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome. DESIGN Retrospective observational case series. METHODS This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity. RESULTS Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1 days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load. CONCLUSIONS Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.
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9
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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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10
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Dorman A, Donaldson M. Acute Retinal Necrosis Multicenter Case Series: Prognostic Indicators and Treatment Outcomes. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2474126418798559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this article is to report the prognostic associations of acute retinal necrosis (ARN), determine the diagnostic utility of aqueous vs vitreous polymerase chain reaction (PCR), and describe outcomes of antiviral, corticosteroid, antithrombotic, and laser retinopexy treatment. Methods: A retrospective, nonrandomized case series was conducted. Primary outcomes included final visual acuity (VA), severe VA loss (≥1.00 log of the minimum angle of resolution [logMAR] [Snellen equivalent, <20/200]), and retinal detachment (RD). Results: Fifty eyes of 46 patients were diagnosed with ARN. Varicella-zoster and herpes simplex viruses were the viral etiology in 29 and 16 eyes, respectively. Five were diagnosed on clinical criteria. Intravenous acyclovir was administered in 90% of eyes. Neither induction therapy for ≥13 days ( P = .692) nor intravitreal medication ( P = .203) decreased the incidence of severe vision loss. Maintenance antiviral medication was administered in 96% of eyes (50% received >13 weeks). At final follow-up, 40% of eyes had severe vision loss (range, –0.08 to +3.0 logMAR [Snellen, 20/17-no perception of light]). Forty-six percent developed RD. Relative afferent pupillary defect (RAPD), zone and extent of retinitis, and RD were prognostic of final VA. Antithrombotic therapy was administered in 25/50 eyes and was associated with lower incidence of severe VA loss ( P = .027) and better final VA ( P = .040). Laser retinopexy was performed in 40% of eyes with no significant effect on RD incidence ( P = .901) or severe VA loss ( P = .451). Conclusions: ARN has a high incidence of RD and poor visual outcomes. Aqueous humor PCR is the first-line diagnostic investigation. Prognostic indicators include RD, RAPD, zone, and extent of retinitis. Induction antiviral medication is appropriate for at least 12 days. Antithrombotic medication is associated with improved outcomes. Laser retinopexy does not reduce the incidence of RD.
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Affiliation(s)
- Andrew Dorman
- Princess Alexandra Hospital, Brisbane, Australia
- Royal Brisbane and Women’s Hospital, Australia
- Gold Coast University Hospital, Australia
- University of Sydney, Australia
| | - Mark Donaldson
- Princess Alexandra Hospital, Brisbane, Australia
- University of Queensland, Australia
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11
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Ansari WH, Pichi F, Pecen PE, Lowder CY, Srivistava SK. Herpes zoster keratitis development after acute retinal necrosis. Int Ophthalmol 2018; 38:829-832. [PMID: 28434069 DOI: 10.1007/s10792-017-0521-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of herpes zoster keratitis in a patient undergoing treatment for herpetic acute retinal necrosis. METHODS Case report. RESULTS A 71 year old male presented with acute retinal necrosis of the left eye due to herpes zoster and was treated with intravitreal foscarnet and oral valcyclovir. He developed a retinal detachment and underwent surgical repair. After four weeks, he developed an ipsilateral herpetic zoster keratitis demonstrated by Rose-Bengal staining that was responsive to topical ganciclovir gel. CONCLUSIONS This case report describes the unusual development of herpes zoster keratitis after the development of unilateral acute retinal necrosis (ARN) in a patient on antiviral treatment.
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Affiliation(s)
- Waseem H Ansari
- Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Avenue Mail Code i13, Cleveland, OH, 44195, USA.
| | - Francesco Pichi
- Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Avenue Mail Code i13, Cleveland, OH, 44195, USA
| | - Paula E Pecen
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Careen Y Lowder
- Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Avenue Mail Code i13, Cleveland, OH, 44195, USA
| | - Sunil K Srivistava
- Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Avenue Mail Code i13, Cleveland, OH, 44195, USA
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12
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Bauer D, Keller J, Alt M, Schubert A, Aufderhorst UW, Palapys V, Kasper M, Heilingloh CS, Dittmer U, Laffer B, Eis-Hübinger AM, Verjans GM, Heiligenhaus A, Roggendorf M, Krawczyk A. Antibody-based immunotherapy of aciclovir resistant ocular herpes simplex virus infections. Virology 2017; 512:194-200. [DOI: 10.1016/j.virol.2017.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
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13
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Yabas Kiziloglu O, Mestanoglu M, Totuk Gedar OM, Adiguzel C, Toygar O. Recurrence of acute lymphoblastic leukemia manifesting as serous retinal detachments and optic disc swelling. Int Ophthalmol 2017; 38:1791-1795. [PMID: 28712034 DOI: 10.1007/s10792-017-0648-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this case report is to describe a patient with acute lymphoblastic leukemia (ALL) who developed bilateral serous retinal detachments and unilateral optic disc swelling. METHODS A 23-year-old woman with ALL presented to the ophthalmology clinic with bilateral subacute visual loss. RESULTS Ophthalmologic examination revealed bilateral serous retinal detachments and unilateral optic disc swelling. Magnetic resonance imaging for differential diagnosis was inconclusive; however, cerebrospinal fluid sampling demonstrated leukemic involvement of the central nervous system. The patient's vision improved and fundus findings resolved with the institution of systemic and intrathecal chemotherapy. CONCLUSIONS Serous retinal detachment and optic disc swelling are unusual ocular manifestations of ALL. They may occur due to leukemic infiltration of ocular structures and may indicate extramedullary recurrence of the disease. Early recognition and treatment is crucial to improve prognosis.
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Affiliation(s)
- Ozge Yabas Kiziloglu
- Department of Ophthalmology, Faculty of Medicine, Göztepe Medical Park Hospital, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey.
| | - Mert Mestanoglu
- Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Ozgun Melike Totuk Gedar
- Department of Ophthalmology, Faculty of Medicine, Göztepe Medical Park Hospital, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey
| | - Cafer Adiguzel
- Department of Hematology, Faculty of Medicine, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey
| | - Okan Toygar
- Department of Ophthalmology, Faculty of Medicine, Göztepe Medical Park Hospital, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey
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14
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Butler NJ, Moradi A, Salek SS, Burkholder BM, Leung TG, Dunn JP, Thorne JE. Acute Retinal Necrosis: Presenting Characteristics and Clinical Outcomes in a Cohort of Polymerase Chain Reaction-Positive Patients. Am J Ophthalmol 2017; 179:179-189. [PMID: 28501392 DOI: 10.1016/j.ajo.2017.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify determinants of adverse outcomes in acute retinal necrosis (ARN), presenting characteristics and incidence rates of vision loss and ocular complications in a cohort of polymerase chain reaction (PCR)-positive eyes were analyzed. DESIGN Retrospective observational cohort study. METHODS Forty-one eyes of 36 patients with clinically diagnosed ARN, PCR-positive for herpes simplex virus or varicella zoster virus and evaluated between January 2002 and June 2013, were included. Main outcome measures included incidence rates of vision loss and retinal detachment (RD). RESULTS Presenting visual acuity was generally poor (20/50 to >20/200 in 27%; 20/200 or worse in 56%). The incidence rate of ≤20/200 was 0.66/eye-year (EY), (95% confidence interval [CI], 0.32/EY to 1.22/EY); the rate of light perception or no light perception vision was 0.07/EY (95% CI, 0.02/EY to 0.16/EY). During follow-up, 59% of eyes developed at least 1 RD (rate = 0.40/EY, 95% CI, 0.19/EY to 0.58/EY). Eyes with retinitis involving ≥25% of the retina at presentation detached at nearly 12 times the rate, as compared to those with <25% retinal involvement (0.70/EY vs 0.06/EY; P = .001). Development of an RD was the greatest determinant of adverse visual outcomes, with 4% of eyes, that had experienced at least 1 RD, achieving a best-corrected visual acuity of ≥20/40 compared to 53% of eyes that never detached (P = .0003). CONCLUSIONS Poor outcomes in ARN were common in this cohort. RD confers the greatest risk of incident vision loss, and once 25% or more of the retina is involved the risk of RD and visual loss increases significantly.
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Affiliation(s)
- Nicholas J Butler
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts.
| | - Ahmadreza Moradi
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sherveen S Salek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryn M Burkholder
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Theresa G Leung
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James P Dunn
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer E Thorne
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Winterhalter S, Stuebiger N, Maier AK, Pleyer U, Heiligenhaus A, Mackensen F, Zierhut M, Joussen AM, Ness T. Acute Retinal Necrosis: Diagnostic and Treatment Strategies in Germany. Ocul Immunol Inflamm 2015; 24:537-43. [PMID: 26399848 DOI: 10.3109/09273948.2015.1034375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To analyze the preferred practice respective diagnosis, treatment, and complications in patients with acute retinal necrosis in Germany. METHODS The uveitis-section of the German Ophthalmologic Society developed a questionnaire with 12 questions concerning patients with acute retinal necrosis seen in the 5 years up to August 2009. RESULTS In total, 35 eye hospitals answered the questionnaire and reported 213 patients with acute retinal necrosis. Diagnosis was made clinically in 86%. Anterior chamber tap, vitreous biopsy, diagnostic vitrectomy, and serology were performed for confirmation. Therapy was started with acyclovir in all institutions, and continued with ganciclovir, foscarnet and brivudine in some cases. Intravitreal injections were performed in 46%. Additional oral steroids were given in 80%. A following oral antiviral treatment was performed in 94%. CONCLUSIONS Relevant variations were seen in diagnosis and treatment practices. The survey outlines the need for a unique diagnostic and therapeutic guideline.
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Affiliation(s)
- Sibylle Winterhalter
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Nicole Stuebiger
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Anna-Karina Maier
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Uwe Pleyer
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Arnd Heiligenhaus
- b Department of Ophthalmology , St Franziskus Hospital of Muenster, University of Duisburg Essen , Essen , Germany
| | - Friederike Mackensen
- c Department of Ophthalmology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Manfred Zierhut
- d Department of Ophthalmology , University Hospital of Tuebingen , Tuebingen , Germany , and
| | - Antonia M Joussen
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Thomas Ness
- e University Eye Center, University Hospital of Freiburg , Freiburg , Germany
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