Exercise during treatment for advanced cervical cancer.

Cervical cancer (CCa) is the fourth most common type of tumour diagnosed in women. Its treatment-related side effects affect patients' quality of life and physical condition. It is known that physical activity (PA) is beneficial to patients with cancer. However, there is a gap in research on this topic in patients with CCa during the treatment phase. In this report, a case is presented to assess the feasibility of a PA programme during chemoradiotherapy in a woman diagnosed with CCa. It is possible to develop PA programmes for patients with advanced CCa. However, no improvement was seen in the physical and functional variables analysed.

Accuracy of 3D printed spine models for pre-surgical planning of complex adolescent idiopathic scoliosis (AIS) in spinal surgeries: a case series.

Adolescent idiopathic scoliosis (AIS) is a noticeable spinal deformity in both adult and adolescent population. In majority of the cases, the gold standard of treatment is surgical intervention. Technological advancements in medical imaging and 3D printing have revolutionised the surgical planning and intraoperative decision making for surgeons in spinal surgery. However, its applicability for planning complex spinal surgeries is poorly documented with human subjects. The objective of this study is to evaluate the accuracy of 3D printed models for complex spinal deformities based on Cobb angles between 40° to 95°.This is a retrospective cohort study where, five CT scans of the patients with AIS were segmented and 3D printed for evaluating the accuracy. Consideration was given to the Inter-patient and acquisition apparatus variability of the CT-scan dataset to understand the effect on trueness and accuracy of the developed CAD models. The developed anatomical models were re-scanned for analysing quantitative surface deviation to assess the accuracy of 3D printed spinal models. Results show that the average of the root mean square error (RMSE) between the 3DP models and virtual models developed using CT scan of mean surface deviations for the five 3d printed models was found to be 0.5±0.07 mm. Based on the RMSE, it can be concluded that 3D printing based workflow is accurate enough to be used for presurgical planning for complex adolescent spinal deformities. Image acquisition and post processing parameters, type of 3D printing technology plays key role in acquiring required accuracy for surgical applications.

Effect of lipoprotein (a) on the analytical determination of low-density lipoprotein cholesterol (LDLc) and its influence on pharmacological treatment with atorvastatin.

Lipoprotein(a) (Lp(a)) and Low-density lipoprotein cholesterol (LDLc) is an important risk factor for atherosclerotic cardiovascular disease. The objective of this study was to determine the impact of Lp(a) concentration both on the indirect analytical measurement of LDLc and on the efficacy of dyslipidaemia treatment using the atorvastatin statin. Two retrospective studies were conducted, one with 340 patients and another with 107 patients treated with atorvastatin. Lp(a) concentrations were measured by turbidimetry with an assay independent of the size of the apo(a) isoform. LDLc was calculated using the Friedewald equation and the corrected LDLc was calculated using the Dahlén equation. A strong positive correlation was observed between the serum Lp(a) concentration and the LDLc-overestimation percentage (r = 0.960, p < .001). It was also observed that as the Lp(a) concentration rose there was no significant variation in the percentage decrease in corrected LDLc during atorvastatin treatment (r = 0.186, p > .05). The concentration of LDLc obtained by using the Friedewald equation included Lp(a) cholesterol. The lowering of LDLc in patients treated with atorvastatin depended solely on accessible LDL cholesterol and not on Lp(a) cholesterol.

Cancer survivor inspiratory muscle training: systematic review and Bayesian meta-analysis.

BACKGROUND: The long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors. METHODS: This systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out. RESULTS: Pooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function. CONCLUSION: IMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery. PROSPERO REGISTRATION NUMBER: 304909.

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery. METHODS: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool. RESULTS: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%). CONCLUSIONS: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.

Nivel de Actividad Física en supervivientes de cáncer de mama españolas. Aplicación del HUNT 1-Physical Activity Questionnaire / Nível de Atividade Física em sobreviventes espanholas de cancro de mama. Aplicação do HUNT 1-Physical Activity Questionnaire / Physical Activity Levels in Spanish Breast Cancer Survivors. Implementation of the HUNT1-Physical Activity Questionnaire

Objetivo: El objetivo de este estudio fue analizar los niveles de actividad física en supervivientes de cáncer de mama españolas a través de un cuestionario autoadministrado. Asimismo, se estudió la relación entre variables personales y clínicas, variables del entrenamiento y calidad de vida.Método: La presente investigación es de tipo no experimental, descriptiva y transversal. De una muestra significativa (n=386) de mujeres supervivientes de cáncer de mama, se registraron, mediante encuesta autoadministrada: datos antropométricos, sociodemográficos y clínicos; niveles de actividad física mediante cuestionario HUNT1-Physical Activity Questionnaire; y calidad de vida, mediante cuestionario específico para cáncer de mama Functional Assessment Cancer Theraphy-Breast (FACT-B).Resultados: El patrón de entrenamiento más habitual fue de 2-3 veces por semana (40.9%), a intensidad ligera (41.7%) en sesiones de 30-60 minutos (51%). La puntuación media en calidad de vida fue de 93±20 puntos (escala 0-148). El índice de masa corporal resultó influir tanto en nivel de actividad física, como en calidad de vida (p<0.001). Respecto a variables clínicas, se encontró relación entre administración de quimioterapia y frecuencia de entrenamiento (p<0.05); estadio de diagnóstico con puntuación total FACT-B (p<0.05); y existencia de comorbilidades sobre subescala física del test de calidad de vida (p<0.05).Conclusiones: Los resultados indicaron que la mayoría de supervivientes de cáncer de mama españolas no cumplen actualmente los niveles de actividad física recomendados. Del mismo modo sugieren que, aunque el estadio de diagnóstico no parece ser determinante en dicho hábito, sí afecta a su calidad de vida. (AU)

Objective: The objective of this study was to analyze the levels of physical activity in Spanish breast cancer survivors through a self-administered questionnaire, and to assess the relationship between personal and clinical variables, training variables and quality of life.Methods: The present research is non-experimental, descriptive and transversal. From a significant sample (n=386) of breast cancer survivors, the following were recorded by self-administered survey: anthropometric, sociodemographic and clinical data; physical activity levels by means of the HUNT1-Physical Activity Questionnaire; and quality of life, by means of the specific Functional Assessment Cancer Theraphy-Breast (FACT-B).Results: The most common training pattern was 2-3 times per week (40.9%), at light intensity (41.7%) in 30-60 minutes sessions (51%). The average quality of life score was 93±20 points (scale 0-148). The body mass index was found to influence both the level of physical activity and quality of life (p<0.001). Regarding clinical variables, we found a relationship between chemotherapy administration and training frequency (p<0.05); diagnostic stage with FACT-B total score (p<0.05); and existence of comorbidities on the physical subscale of the quality of life test (p<0.05).Conclusions: The results indicated that the majority of Spanish breast cancer survivors do not currently meet the recommended levels of physical activity. They also suggest that, although the stage of diagnosis does not seem to be a determining factor in this habit, it does affect their quality of life. (AU)

Objectivo: O objectivo deste estudo foi analisar os níveis de actividade física dos sobreviventes espanhóis do cancro da mama através de um questionário auto-administrado e avaliar a relação entre as variáveis pessoais e clínicas, as variáveis de treino e a qualidade de vida.Métodos: A presente investigação é não experimental, descritiva e transversal. A partir de uma amostra significativa (n=386) de sobreviventes de cancro da mama, foram registados, por inquérito auto-administrado: dados antropométricos, sociodemográficos e clínicos; níveis de actividade física, através do questionário HUNT1-Physical Activity Questionnaire; e qualidade de vida, através do questionário específico Functional Assessment Cancer Theraphy-Breast (FACT-B).Resultados: O padrão de treino mais comum foi 2-3 vezes por semana (40.9%), com intensidade luminosa (41.7%) em sessões de 30-60 minutos (51%). A pontuação média da qualidade de vida foi de 93±20 pontos (escala 0-148). O índice de massa corporal influenciou tanto o nível de actividade física como a qualidade de vida (p<0.001). Em relação às variáveis clínicas, encontramos uma relação entre a administração da quimioterapia e a frequência do treino (p<0.05); fase de diagnóstico com pontuação total FACT-B (p<0.05); e existência de comorbidades na subescala física do teste de qualidade de vida (p<0.05).Conclusões: Os resultados indicaram que a maioria dos sobreviventes espanhóis de cancro da mama não atinge actualmente os níveis recomendados de actividade física. Sugerem também que, embora a fase do diagnóstico não pareça ser um factor determinante neste hábito, ela afecta a sua qualidade de vida. (AU)

Fatiga relativa al cáncer: factores desencadenantes y función del ejercicio físico / Cancer-related fatigue: trigger factors and physical exercise role

Introducción: Diversas publicaciones han teorizado sobre los desencadenantes de la fatiga relativa al cáncer, uno de losefectos secundarios de la enfermedad y sus tratamientos que más estresa a los supervivientes de esa enfermedad. Por otrolado, el ejercicio físico ha sido analizado como terapia para reducir el impacto de esta secuela, y diversas instituciones apoyansu inclusión dentro de los programas de cuidado para población oncológica. No obstante, la fatiga en cáncer y el papel queel entrenamiento tiene para su control, se ha expuesto sin realizar una valoración global que muestre su complejidad y porqué el ejercicio físico resulta de tanto valor para reducirla.Objetivos: El objetivo de este trabajo fue revisar la evidencia existente sobre los desencadenantes de fatiga en cáncer, paraexponer en qué modo el ejercicio físico actúa sobre cada uno de ellos para controlar su sintomatología y conseguir un efectoterapéutico integral.Material y método: Se realizaron diversas búsquedas bibliográficas que permitieran conocer cuáles eran los desencadenantesde fatiga propuestos por la investigación, cómo se desarrollan y afectan al paciente oncológico y, por último, en qué gradoel ejercicio físico sería una herramienta viable para controlar sus efectos.Resultados: Expuestos más de una veintena de desencadenantes y agravantes de la fatiga relativa al cáncer, encontramosque la mayoría de ellos podrían ser prevenidos o al menos controlados a través del ejercicio físico.Conclusiones: Resulta imposible aislar unos desencadenantes de otros, existiendo, además, algunos de ellos que son inevita-bles al ser parte del tratamiento médico de la enfermedad. Entender las relaciones que se producen entre desencadenantes yconocer los efectos positivos del ejercicio físico sobre cada uno de ellos, es claramente útil para controlar este efecto secundario.(AU)

Introduction: Several publications have theorized about the triggers of cancer-related fatigue, one of the side effects ofthe disease and its treatments that most stress cancer survivors. On the other hand, physical exercise has been analyzedas a therapy to reduce the impact of this sequel, and several institutions support its inclusion within care programs for theoncological population. However, cancer fatigue and the role that exercise plays in its control has been exposed without anoverall assessment that shows its complexity and why physical exercise is so valuable to reducing it.Objectives: The objective of this work was to review the existing evidence about triggers of fatigue in cancer, to expose howphysical exercise acts on each of them to control their symptoms and achieve a comprehensive therapeutic effect.Material and method: Several bibliographic searches were carried out to find out which were the triggers of fatigue proposedby the research, how they develop and affect the oncological patient and, finally, to what extent physical exercise would bea viable tool to control its effects.Results: Exposed to more than twenty triggers and aggravating factors of cancer-related fatigue, we found that most of themcould be prevented or at least controlled through physical exercise.Conclusions: It is impossible to isolate some triggers from others, and some of them are inevitable as they are part of themedical treatment of the disease. Understanding the relationships between triggers and knowing the positive effects ofphysical exercise on each one of them is clearly useful to control this side effect.(AU)

External validation of cut-off points for foveal thickness taking into account the intraretinal fluid using optical coherence tomography to diagnose diabetic macular oedema.

BACKGROUND: In late 2015, cut-off points were published for foveal thickness to diagnose diabetic macular oedema taking into account the presence of intraretinal fluid using optical coherence tomography (OCT) in primary care patients (90 µm in the presence of intraretinal fluid and 310 µm otherwise). METHODS: This cross-sectional observational study was carried out on 134 eyes of diabetic patients treated in specialised ophthalmology services in a Spanish region in 2012-2013, to externally validate the aforementioned cut-off points. The main variable (Clinical Standard) was the diagnosis of macular oedema through indirect ophthalmoscopy and posterior segment slit-lamp biomicroscopy. As validation variables, both the foveal thickness and the presence of intraretinal fluid obtained by OCT were used. Validation was performed using bootstrapping by calculating the area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). RESULTS: Forty-one eyes presented diabetic macular oedema (30.6%). The bootstrapping validation parameters were: AUC, 0.88; sensitivity, 0.75; specificity, 0.95; PLR, 14.31; NLR, 0.26. These values were very similar to those of the original publication. CONCLUSION: We have externally validated in specialised care patients the cut-off points published for the diagnosis of diabetic macular oedema. We suggest that others carry out validation studies in their communities.

Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid.

UNLABELLED: No studies have yet evaluated jointly central foveal thickness (CFT) and the presence of intraretinal fluid (PIF) to diagnose diabetic macular oedema (DMO) using optic coherence tomography (OCT). We performed a cross-sectional observational study to validate OCT for the diagnosis of DMO using both CFT and PIF assessed by OCT (3D OCT-1 Maestro). A sample of 277 eyes from primary care diabetic patients was assessed in a Spanish region in 2014. OUTCOME: DMO diagnosed by stereoscopic mydriatic fundoscopy. OCT was used to measure CFT and PIF. A binary logistic regression model was constructed to predict the outcome using CFT and PIF. The area under the ROC curve (AUC) of the model was calculated and non-linear equations used to determine which CFT values had a high probability of the outcome (positive test), distinguishing between the presence or absence of PIF. Calculations were made of the sensitivity, specificity, and the positive (PLR) and negative (NLR) likelihood ratios. The model was validated using bootstrapping methodology. A total of 37 eyes had DMO. AUC: 0.88. Positive test: CFT ≥90 µm plus PIF (≥310 µm if no PIF). Clinical parameters: sensitivity, 0.83; specificity, 0.89; PLR, 7.34; NLR, 0.19. The parameters in the validation were similar. In conclusion, combining PIF and CFT provided a tool to very precisely discriminate the presence of DMO. Similar studies are needed to provide greater scientific evidence for the use of PIF in the diagnosis of DMO.

Validity of Optical Coherence Tomography as a Diagnostic Method for Diabetic Retinopathy and Diabetic Macular Edema.

To validate optical coherence tomography (OCT) for the diagnosis of referable retinopathy (severe, very severe or proliferative retinopathy, and macular edema) in diabetic patients. We performed a cross-sectional observational study. A random sample was analyzed comprising 136 eyes of diabetic patients referred to the hospital in Elche (Spain) with suspected referable retinopathy between October 2012 and June 2013. Primary variable: Referable retinopathy measured by ophthalmological examination of the retina. OCT data included: central foveal thickness, presence of intraretinal fluid, and fundus photographs. The receiver operating characteristic (ROC) curve was calculated to determine the minimum thickness value with a positive likelihood ratio >10. To determine the validity of OCT, the following diagnostic test was defined: Positive: if the patient had at least 1 of these criteria: foveal thickness greater than the point obtained on the previously defined ROC curve, intraretinal fluid, abnormal fundus photographs; Negative: none of the above criteria. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and Kappa statistic were determined. Of the 136 eyes, 48 had referable retinopathy (35.3%, 95% confidence interval [CI]: 27.3-43.3). The minimum thickness value with a positive likelihood ratio >10 was 275 µm. The diagnostic test constructed showed: sensitivity, 91.67% (95% CI: 79.13-97.30); specificity, 93.18% (95% CI: 85.19-97.20); positive predictive value, 88.00% (95% CI: 75.00-95.03); negative predictive value, 95.35% (95% CI: 87.87-98.50); positive likelihood ratio, 13.44 (95% CI: 6.18-29.24); negative likelihood ratio, 0.09 (95% CI: 0.03-0.23). The Kappa value was 0.84 (95% CI: 0.75-0.94, P < 0.001. This study constructed a diagnostic test for referable diabetic retinopathy with type A evidence. Nevertheless, studies are needed to determine the validity of this test in the general diabetic population.

Bacteriemia por enterobacterias resistentes a carbapenems: Un estudio transversal / Bacteremia due to carbapenem-resistant Enterobacteriaceae: A cross-sectional study

Objetivos: Describir las características clínicas, los esquemas de antibiótico empleados y el pronóstico en términos de mortalidad intrahospitalaria y efectos adversos en pacientes con bacteriemia por enterobacterias con prueba fenotípica para carbapenemasas positiva. Material y métodos: Estudio de corte trasversal en un hospital de tercer nivel (Medellín, Colombia), en pacientes con bacteriemia por enterobacterias resistentes a carbapenems (CRE) detectados entre enero del 2010 y diciembre del 2013. Se presentan las variables continuas con medianas y rangos intercuartiles (RIQ) y las categóricas con porcentajes. Resultados: Se incluyeron 64 casos con un promedio de edad de 62 ± 14 años, 66% (n = 42) hombres. El 60% (n = 38) se encontraban en la UCI, y la mediana de APACHE-II fue de 17 (RIQ: 12-22), con alta comorbilidad (puntaje Charlson de 3; RIQ: 2-5). La mediana de estancia previa a la bacteriemia fue de 21 días (RIQ: 13-39). El 64% correspondieron a Klebsiella pneumoniae , el 20% a Serratia marcescens y el 11% a Enterobacter spp. El 45% tenían tamización positiva previa a la bacteriemia. La mortalidad a los 28 días fue del 51,6% (n = 33) y ocurrió con una mediana de 5 días luego de detectada la bacteriemia (RIQ: 2-17). El tratamiento definitivo fue combinado en el 76,6% de los casos, pero no hubo un esquema de combinación prevalente. Se reportaron efectos adversos en uno de cada 3 pacientes, y la mediana de estancia hospitalaria fue de 46 días (RIQ: 26-76). La mortalidad a 28 días de pacientes tratados con carbapenems (n = 27), colistina (n = 27) o tigeciclina (n = 18), solos o en cualquier combinación, fue del 40,7, del 55,2 y del 55,7%, respectivamente. Discusión: Los pacientes incluidos tenían altos índices de comorbilidad y exposición al ambiente nosocomial, como en estudios previamente publicados. La mortalidad a 28 días fue comparable a la reportada en otros estudios. Se encontró menor mortalidad en pacientes tratados con terapias combinadas que incluían carbapenems, similar a lo reportado en un estudio clínico reciente en pacientes con bacteriemia por Klebsiella pneumoniae productora de carbapenemasas. Conclusiones: La bacteriemia por CRE afecta pacientes muy enfermos y se acompaña de elevadamortalidad. Se detecta colonización en casi la mitad de los pacientes antes del desarrollo deinfección. Hay heterogeneidad en el manejo antimicrobiano, pero la inclusión de carbapenemsen el esquema de tratamiento combinado podría asociarse con menor mortalidad.

Objectives: To describe the clinical features, antibiotic regimes and prognosis in terms of inpatient mortality and adverse effects in patients with Enterobacteriaceae bacteremia anda positive carbapenemase-detecting phenotypic test. Materials and methods: A cross-sectional study was conducted at a tertiary hospital (Medellín,Colombia). Patients with blood stream infections by carbapenems-resistant Enterobacteriaceae(CRE) diagnosed from January, 2010 to December, 2013 were included. Continuous variables are presented as medians and interquartile ranges (IQR), and categorical variables are presentedas percentages. Results: Sixty-four cases were included, with a mean age of 62 ± 14; 66% were male (n = 42).A total of 60% (n = 38) were admitted to the ICU and the median APACHE-II score was 17 (IQR:12-22), with high comorbidity (Charlson score = 3, IQR: 2-5). The median hospital stay prior to the diagnosis of bacteremia was 21 days (IQR: 13-39). Klebsiella pneumoniae was isolated in 64%, Serratia marcescens in 20% and Enterobacter spp. in 11% of the cases. Some 45% had apositive screening before the diagnosis of bacteremia. Mortality at 28 days was 51.6% (n = 33)and occurred in a median of 5 days (IQR: 2-17) after bloodstream infection was detected. Definitive treatment was a combination of antibiotics for 76.6%, but no combination scheme was prevalent. Adverse effects were observed in one of 3 patients and the median hospital stay was46 days (IQR: 26-76). Mortality at 28 days was 40.7% when patients were treated with a combination that included carbapenems agents (n = 27), compared with 55.2% for colistin (n = 27) and 55,7% for tigecycline (n = 18). Discussion: A high comorbidity index and nosocomial environment exposure were observed,as in previously published studies. The 28-day mortality was comparable to that reported inother studies. There was less mortality in patients treated with a combination that includeda carbapenem agent, as was reported in a recent clinical study on patients with bacteremia Klebsiella pneumoniae carbapenemase. Conclusions: CRE bacteremia is seen in very ill patients and is associated with high mortality. Bacterial colonization was detected in nearly half the patients prior to development of infection. The current antimicrobial therapy is heterogeneous, but the inclusion of a carbapenems agent in combination therapy may be associated with lower mortality.

Presumed bilateral acute retinal necrosis 11 years apart, atypical presentation, and early vitrectomy.

PURPOSE: To report a case of presumed bilateral acute retinal necrosis with delayed onset caused by herpes simplex virus type 2, medical treatment, and surgical approach. METHODS: Retrospective, interventional case described in a 51-year-old patient who complained of unilateral blurred vision with history of nonoperated retinal detachment in his fellow eye after posterior uveitis 11 years earlier. RESULTS: Ocular examination suggested diagnosis of acute retinal necrosis involving the posterior pole and sparing periphery. The causative agent was demonstrated using polymerase chain reaction analysis of the aqueous humor. Intensive medical treatment with intravenous acyclovir, intravitreous foscarnet, and corticosteroids was administered, slowing down but not stopping progression of the disease. Due to the monocular status of the patient and high probability of secondary retinal detachment, early vitrectomy was indicated. CONCLUSIONS: Rapid and aggressive medical treatment is necessary in this condition. Bilateral involvement often occurs within weeks, but can also happen more rarely after several months or years, requiring long-term follow-up. Early surgical treatment is controversial but it is an option to be considered in certain cases.