ABSTRACT
Resumen Presentamos el caso de un varón de 63 años, inmunocompetente, con una necrosis retinal aguda (NRA) unilateral. Consultó por visión borrosa, dolor ocular, fotofobia y cefalea. Se confirmó una papilitis y coriorretinitis periférica asociada a vasculitis e isquemia retinal periférica. El estudio molecular por RPC de humor acuoso detectó la presencia de virus varicela zoster. El paciente fue tratado con terapia combinada con corticoesteroides orales, aciclovir oral/intravenoso, ganciclovir intravítreo semanal y luego valaciclovir oral por tres meses. Se demostró una disminución progresiva de la carga viral en el humor acuoso durante el tratamiento. El seguimiento mostró una mejoría del cuadro inflamatorio y una leve recuperación de la agudeza visual, sin embargo, finalmente presentó un desprendimiento de retina con pérdida casi total de la visión unilateral. La NRA es una complicación infrecuente provocada por algunos virus herpes con mal pronóstico visual, desenlace que puede ser mejorado con un diagnóstico y tratamiento precoz con antivirales. El tratamiento prolongado permite evitar la recaída y el compromiso contralateral.
Abstract We present the case of a 63-year-old immunocompetent man with unilateral acute retinal necrosis (ARN). He consulted for blurred vision, eye pain, photophobia, and headache. Papillitis and peripheal chorioretinitis associated with vasculitis and peripheral retinal ischemia was confirmed. PCR from aqueous humor sample detected varicella zoster virus. The patient was treated with a combined therapy of oral corticosteroids, oral / intravenous acyclovir along with weekly intravitreous ganciclovir doses followed by oral valaciclovir for three months. A progressive decrease in viral load in aqueous humor was demonstrated during treatment. Follow-up showed improvement in the inflammatory condition and a slight recovery of visual acuity, however, finally he presented a retinal detachment with total loss of one-sided vision. ARN is an uncommon complication caused by some herpesviruses with a poor visual prognosis, an outcome that can be improved with early diagnosis and treatment using appropriate antivirals. Prolonged treatment reduces relapse frequency and fellow eye compromise.
Subject(s)
Humans , Male , Middle Aged , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Herpesvirus 3, Human/genetics , Antiviral Agents/therapeutic use , Acyclovir/therapeutic use , Polymerase Chain Reaction , Follow-Up StudiesABSTRACT
RESUMO A toxoplasmose ocular pode se manifestar de forma atípica, rara, bilateral e associada à necrose retiniana aguda. É apresentada em pacientes imunossuprimidos, resultando em grave perda visual, se não for solucionada rapidamente. Relata-se um caso atípico de toxoplasmose ocular em paciente diabético, que, em sua internação prévia, já evidenciava aspecto sistêmico, o qual foi elucidado pelo exame clínico oftalmológico e pela anamnese. Além disso, a rotina do setor de uveítes, ao solicitar as sorologias de forma direcionada e criteriosa, foi imprescindível para o diagnóstico da toxoplasmose sistêmica associado à lesão ocular atípica bilateral, mimetizando necrose retiniana aguda com desfecho favorável.
Abstract Ocular toxoplasmosis can present with an atypical, rare, bilateral involvement, and associated with acute retinal necrosis. It occurs in immunosuppressed patients, resulting in severe visual loss, if not quickly solved. We report an atypical case of ocular toxoplasmosis in a diabetic patient, who already showed a systemic aspect in a previous hospitalization, which was elucidated by the ophthalmologic examination and history. In addition, the routine of the uveitis sector requesting serology in a directed and careful way was essential for the diagnosis of systemic toxoplasmosis associated with atypical bilateral ocular lesion, mimicking acute retinal necrosis with good outcome.
Subject(s)
Humans , Male , Adult , Retinal Necrosis Syndrome, Acute/diagnosis , Toxoplasmosis/diagnosis , Toxoplasmosis, Ocular/diagnosis , Retina/diagnostic imaging , Fluorescein Angiography , Visual Acuity , Retinal Necrosis Syndrome, Acute/drug therapy , Toxoplasmosis/drug therapy , Toxoplasmosis, Ocular/drug therapy , Tomography, Optical Coherence , Slit Lamp Microscopy , Fundus Oculi , Infectious MononucleosisABSTRACT
RESUMEN La retinitis necrotizante aguda, es una necrosis retinal de todas las capas de la retina. Se caracteriza por necrosis fibrinoides de la pared de los vasos y oclusión vascular. Se presentó un caso de una paciente de 42 años de edad, con pérdida brusca de la visión del ojo derecho, con una semana de evolución. Al examen oftalmológico se observó haze vítreo 2+, edema sucio del disco óptico, con borramiento de todos sus bordes. Presencia de exudación blanca-amarillenta retiniana extensa, en toda la periferia y área ecuatorial asociada a hemorragias intraretinianas. Se realizó además del examen fundoscòpico toma de muestra de humor acuoso para reacción en cadena de la polimerasa y angiografía fluoresceínica. Los signos fundoscópicos de la paciente, así como las anomalías detectadas en la angiografía fluoresceínica sugirieron el diagnóstico clínico de síndrome de necrosis retinal aguda. Se confirmó el diagnóstico etiológico viral, semanas después por el resultado de polimerasa. Se practicó la terapéutica médica y fotocoagulación laser focal retiniano correspondiente, asociado a cirugía del desprendimiento de retina mixto mediante vitrectomía pars plana y se logró la re aplicación de la retina.
ABSTRACT The acute necrotizing retinitis is a retinal necrosis of all the retinal layers. It is characterized by fibrinoid necrosis of the vases' wall and vascular occlusion. The case presented is the case of a female patient aged 42 years, who suffers sudden loss of the left eye vision, with a week of evolution. At the ophthalmologic examination it was observed a 2+ vitreous haze, dirty edema of the optic disk, with effacement of all of its margins. There it was an extended white-yellowish retinal exudation in the entire periphery and the equatorial area, associated to intra-retinal hemorrhages. Besides the funduscopic examination, it was taken a sample of the aqueous humor for a polymerase chain reaction (PCR) and fluorescein angiography. The patient's funduscopic signs, and also the anomalies detected in the fluorescein angiography suggested the clinical diagnosis of acute retinal necrosis syndrome. After several weeks, the viral etiologic diagnosis was confirmed by polymerase chain reaction. It was practiced the correspondent medical therapeutics and focal retinal laser coagulation associated to mixt retinal detachment through pars plana vitrectomy; the retina reapplication was achieved.
Subject(s)
Humans , Female , Adult , Retinal Detachment/surgery , Retinal Necrosis Syndrome, Acute/complications , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/etiology , Retinal Necrosis Syndrome, Acute/drug therapy , Uveitis, Anterior/complications , Vitrectomy/methods , Retinal Detachment/diagnosis , Acyclovir/therapeutic use , Keratitis, Herpetic/drug therapyABSTRACT
Se describen las características principales de la necrosis retinal aguda, la relación fisiopatológica con su principal diagnóstico diferencial, la necrosis retinal externa progresiva. Exponemos las diferencias clínicas y paraclínicas de ambas enfermedades, con base en las cuales construimos un sistema de clasificación que las contempla como un espectro continuo de enfermedad dependiente del estado inmunológico.
The main characteristics of acute retinal necrosis, the pathophysiological connection with the main differential diagnosis and progressive outer retinal necrosis are described. We analize the clinical and paraclinical differences of both diseases, based on which we built a classifi cation system that take them into a continuous spectrum dependent of the immune state.
Subject(s)
Retinal Necrosis Syndrome, Acute/epidemiology , Chorioretinitis/diagnosis , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/therapyABSTRACT
Retinitis and panuveitis in immunocompetent patients is a rare and sight-threatening disease, of difficult diagnosis. A case of a 31-year-old male who presented with unilateral placoid retinitis and panuveitis, unsuccessfully treated as acute retinal necrosis, that in fact was syphilis, with neurosyphilis and excellent response to treatment is reported.
Retinite com panuveíte em pacientes imunocompetentes é um condição rara e ameaçadora para a visão, e de difícil diagnóstico. É relatado um caso de um paciente do sexo masculino com 31 anos de idade, que se apresentou com retinite em placas e panuveíte, inicialmente tratado sem sucesso como necrose aguda de retina, que na verdade era um caso de sífilis ocular, com afecção do sistema nervoso central e ótima resposta ao tratamento sistêmico para sífilis.
Subject(s)
Adult , Humans , Male , Eye Infections, Bacterial/complications , Panuveitis/microbiology , Retinal Necrosis Syndrome, Acute/diagnosis , Retinitis/microbiology , Syphilis/diagnosis , Diagnosis, Differential , Eye Infections, Bacterial/drug therapy , Panuveitis/drug therapy , Penicillins/therapeutic use , Retinitis/drug therapy , Syphilis/complications , Syphilis/drug therapyABSTRACT
We report a case of a 45-year old Filipino post-kidney transplant patient maintained on steroids, who presented with floaters in her left eye. Vitreous aspirate was analyzed using polymerase chain reaction (PCR) for human cytomegalovirus (HCMV) and herpes simplex virus (HSV). A distinct band (435 bp) was found that confirmed the presence of HCMV. Since a rapid and accurate diagnosis is crucial for prompt administration of antiviral therapy, PCR-based analysis of vitreous aspirate provides a valuable tool in the diagnosis of patients with retinitis caused by herpes viruses.
Subject(s)
Cytomegalovirus/isolation & purification , Cytomegalovirus Infections/complications , Eye Infections, Viral/diagnosis , Female , Humans , Middle Aged , Polymerase Chain Reaction , Retinal Necrosis Syndrome, Acute/diagnosis , Visual AcuityABSTRACT
La necrosis retinal aguda (NRA) es una afección grave que amenaza la visión. Se describe en adultos, en especial aquellos profundamente inmunocompro-metidos, como consecuencia de la reactivación de virus del grupo herpes. Presentamos un paciente de 4 años de edad, con una leucemia de alto riesgo, que durante una quimioterapia intensa desarrolló una varicela con compromiso visceral, incluyendo la retina, lo que le causó ceguera unilateral. En el humor vitreo se detectó ADN de virus varicela-zoster, pese al tratamiento con aciclovir. La visión del ojo contralateral permaneció indemne.
Acute retinal necrosis (ARN) is a serious condition that can impair vision. It mostly occurs in adult patients, especially those severely immunocompromised, in association with a reactivation of a herpes virus infection. We present a 4 years old patient with high risk acute leukemia, whom during a course of intense chemotherapy acquired chickenpox with visceral involvement that affected the retina, causing unilateral blindness. Varicella-zoster virus was detected by PCR in the vitreous humor, in spite of previous acyclovir treatment. The contralateral vision remained undamaged.
Subject(s)
Child, Preschool , Humans , Male , Chickenpox/complications , Immunocompromised Host , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Retinal Necrosis Syndrome, Acute/virology , Antiviral Agents/therapeutic use , Chickenpox/diagnosis , Chickenpox/drug therapy , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapyABSTRACT
La necrosis retinal aguda (NRA) es una afección grave que amenaza la visión. Se presenta en adultos, en especial aquellos profundamente inmunocompro-metidos, como consecuencia de la reactivación de virus del grupo herpes. Se revisan la entidad clínica de la NRA, su diagnóstico nosológico y etiológico, como el manejo recomendado actualmente.
Acute retinal necrosis (ARN) is a serious condition that can impair vision. It mostly occurs in adult patients, especially those severely immunocompromised, in association with a reactivation of a herpes virus infection. Clinical and ophtalmological features of ARN and recommended diagnostic and management strategies are reviewed.
Subject(s)
Adult , Child , Humans , Retinal Necrosis Syndrome, Acute , Antiviral Agents/therapeutic use , Diagnosis, Differential , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Retinal Necrosis Syndrome, Acute/virologyABSTRACT
Due to the devastating nature of acute retinal necrosis syndrome (ARNS), early diagnosis is essential. 5 cases of clinically diagnosed ARNA were investigated for CMC, herpes simplex and varicella zoster virus (VZV) infections. Of the three VZV IgM positive cases, two were positive in acute blood samples and one in vitreous fluid. Thus VZU can be incriminated as the causative agent of ARNS cases in North India.
Subject(s)
Adult , Eye Infections, Viral/epidemiology , Female , Herpes Zoster/diagnosis , Herpesvirus 3, Human/immunology , Humans , Male , Middle Aged , Retinal Necrosis Syndrome, Acute/diagnosis , Serologic Tests , Vitreous Body/immunologyABSTRACT
The present report describes a case where HSV was detected by polymerase chain reaction (PCR) in the lens cortical material removed during cataract surgery one year after resolution of retinal inflammation in a patient with ARN.
Subject(s)
Adult , DNA Primers/chemistry , DNA, Viral/analysis , Diagnosis, Differential , Eye Infections, Viral/diagnosis , Herpes Simplex/diagnosis , Herpesvirus 1, Human/genetics , Humans , Lens Diseases/diagnosis , Male , Polymerase Chain Reaction , Retinal Necrosis Syndrome, Acute/diagnosisABSTRACT
PURPOSE: To review our experiences on the laboratory investigations of viral and chlamydial conjunctivitis, congenital cataract and acute retinal inflammations seen from 1990 to 1998 at Sankara Nethralaya, Chennai, India. METHODS: Conjunctival swabs/scrapings from 1061 patients with conjunctivitis were investigated. Nested polymerase chain reaction (nPCR) and restriction fragment length polymorphism (RFLP) techniques were applied on 74 conjunctival swabs during the 1996 outbreak of acute viral conjunctivitis. The occurrence of Rubella virus in 86 lens aspirates of congenital cataract was investigated. Tests were performed for the association of Herpes simplex virus (HSV), Varicella zoster virus (VZV) and Cytomegalovirus (CMV) with acute retinal inflammation in 32 patients. RESULTS: The causative agents of conjunctivitis were Adenovirus in 13.8%, HSV in 2.2% and C. trachomatis in 20.9% of the patients. Epidemics were due to Adenovirus type 4 in 1991, type 3 in 1992-93 and type 7a in 1996. PCR was 37.9% more sensitive in detecting Adenovirus than virological methods. RFLP identified the conjunctivitis epidemic strain of 1996 as Adenovirus 7a. Rubella virus was isolated from 8.1% of lens aspirates from congenital cataract. Nineteen of the 32 patients with acute retinitis had confirmed virus infections (VZV: 8; HSV: 5; and CMV: 6) and the rapid detection of the virus agent helped institute specific chemotherapy resulting in useful vision in some patients. CONCLUSION: Laboratory investigations for diagnosis of viral and C. trachomatis ocular infections were useful in establishing the aetiology and determining the incidence of causative agents of specific ocular diseases.
Subject(s)
Antibodies, Bacterial/analysis , Antibodies, Viral/analysis , Cataract/congenital , Chlamydia trachomatis/genetics , Conjunctivitis, Viral/diagnosis , DNA, Bacterial/analysis , DNA, Viral/analysis , Diagnosis, Differential , Humans , Polymerase Chain Reaction , Retinal Necrosis Syndrome, Acute/diagnosis , Trachoma/diagnosis , Viruses/geneticsABSTRACT
Se estudian 17 ojos de 13 pacientes con el diagnóstico de necrosis retinal aguda evaluados en el Hospital Clínico de la Universidad de Chile y en la Fundación Oftalmológica Los Andes con el propósito de evaluar las características clínicas y los resultados del tratamiento con fotocoagulación láser. Todos los pacientes eran inmunocompetentes, con edad promedio de 33 años, siendo la necrosis bilateral en el 39,8 por ciento. Se dividen los pacientes en grupo I, quienes presentaban enfermedad avanzada y/o desprendimiento de retina al momento del diagnóstico, y en grupo II a los cuales se les realizó el diagnóstico de forma relativamente precoz y recibieron tratamiento adecuado con aciclovir endovenoso y láser profiláctico. El desprendimiento de retina se presentó en todos los pacientes no tratados con láser y en el 20 por ciento de los tratados. Cinco pacientes con desprendimiento retinal y vitreorretinopatía proliferativa fueron manejados con vitrectomía con gas o aceite de silicona. La retina quedó aplicada en todos ellos pero sólo uno conservó visión útil. Los resultados visuales se relacionaron con la precocidad del diagnóstico, el tratamiento médico oportuno y el empleo de láser profiláctico
Subject(s)
Humans , Light Coagulation/methods , Lasers/therapeutic use , Retinal Necrosis Syndrome, Acute/surgery , Acyclovir/therapeutic use , Retinal Detachment/etiology , Retinal Detachment/surgery , Retinal Necrosis Syndrome, Acute/complications , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Visual Acuity , Vitrectomy , Vitreoretinopathy, Proliferative/etiology , Vitreoretinopathy, Proliferative/surgeryABSTRACT
Se revisa la literatura y se presenta el caso de un paciente con diagnóstico clínico de síndrome de necrosis retiniana aguda, quien presentó un cuadro severo y fulminante caracterizado por una retinitis difusa acompañada de fenómenos vasculares oclusivos importantes y áreas de necrosis retiniana.
Subject(s)
Adolescent , Humans , Male , Retinal Diseases/physiopathology , Retinal Detachment/prevention & control , Light Coagulation/methods , Visual Perception/physiology , Keratitis, Herpetic/therapy , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/physiopathologyABSTRACT
A 42 year old man presented with acute bilateral uveitis and necrotizing retinitis. Systemic investigations including test for AIDS and CMV retinitis were negative. Despite oral Acyclovir, both eyes progressed rapidly to retinal detachment with loss of vision. Early recognition is necessary to diagnose the bilateral acute retinal necrosis syndrome and initiate treatment. Bilateral acute retinal necrosis (BARN) is a term first coined by Young and Bird in 1978 although the syndrome had been originally described by Urayama et al as an unilateral condition. This syndrome is characterized by the triad of acute confluent peripheral necrotizing retinitis, moderate to severe vasculitis and vitritis in an otherwise healthy individual. Rhegmatogenous retinal detachment occurs within two to three months of the onset of the disease and the second eye is involved in 36% of patients, usually within 6 weeks. We herein report a patient who presented with simultaneous BARN leading to retinal detachment in a matter of days. Also, to our knowledge this is the first report of this condition in India.
Subject(s)
Adult , Fluorescein Angiography , Fundus Oculi , Humans , Male , Retinal Detachment/diagnosis , Retinal Necrosis Syndrome, Acute/diagnosisABSTRACT
La infección retinal por el virus de la Varicela Zoster es una de las causas del síndrome de necrosis retinal aguda. Se describe un caso de una paciente con cuadro típico de dermatitis Zoster asociado a neuritis óptica y zonas de necrosis retinal