HSV2 acute retinal necrosis: diagnosis and monitoring with quantitative polymerase chain reaction.

PURPOSE: To describe a case of HSV2 acute retinal necrosis (ARN) diagnosed and monitored with quantitative polymerase chain reaction (PCR) in ocular fluids. DESIGN: Case report. METHODS: Quantitative PCR was performed in the aqueous humor (AH) and vitreous using primers specific for herpes virus. RESULTS: A positive PCR was found for HSV2 in the AH (>100,000,000 viral copies - 8.00 log/ml). After therapy, another anterior chamber tap showed a reduction of the viral load at 4.28 log/ml (19205 copies), confirming the efficacy of the treatment. After six months, PCR on the vitreous still showed the presence of HSV2 viral particles in the eye (3.14 log DNA copies/ml, 1379 copies) although the lesion was healed. CONCLUSIONS: This case demonstrates that PCR is useful to detect viral DNA in AH and vitreous and to monitor viral activity and therapeutic response. Viral DNA persists in ocular fluids for months in the presence of a healed infection.

Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid.

BACKGROUND: The effects of ursodeoxycholic acid on human placental bile acids and bilirubin transporters in intrahepatic cholestasis of pregnancy are still undefined. AIM: To evaluate whether ursodeoxycholic acid affects MRP2, MRP3 and MRP4 expression in the placenta. MATERIALS AND METHODS: Forty-three pregnant women were enrolled; fourteen subjects had physiological pregnancies. Intrahepatic cholestasis of pregnancy patients were divided into two groups: (i) 13 received ursodeoxycholic acid (20 mg/kg/day) and (ii) 16 untreated. Total bile acid and bilirubin in serum and cord blood were determined in each subject. Multidrug resistance proteins expression (immunoblot, quantitative real-time PCR) was evaluated in placentas collected at delivery. anova test was used for statistical analysis of data. RESULTS: Ursodeoxycholic acid administration significantly improved maternal serum bile acid and cord blood bilirubin and bile acid levels. MRP2 protein and RNA expression was significantly increased in placentas from treated patients compared to controls (P < 0.001 and P < 0.01, respectively). MRP3 protein expression was not significantly different between the groups while RNA expression was significantly decreased in treated patients (P < 0.01). MRP4 did not show significant differences between the groups. CONCLUSIONS: Ursodeoxycholic acid administration induces placental MRP2 expression, and reduces bilirubin and bile acid levels in cord blood.

Bartonella henselae infection presenting as a unilateral acute maculopathy.

BACKGROUND: The purpose of this article is to report an unusual ocular manifestation of cat scratch disease (CSD) presenting as a unilateral acute maculopathy (UAM). We describe and review the clinical, laboratory, fluorescein angiography (FA), indocyanine green angiography (ICG) and optical coherence tomography (OCT) records of a patient with CSD. HISTORY AND SIGNS: A 30-year-old Chinese woman presented with a painless progressive visual loss affecting her left eye. Fundus examination of the left eye disclosed rare vitreous cells and a deep-creamy choroidal macular lesion with satellite foci of choroiditis. THERAPY AND OUTCOME: FA revealed an early hypofluorescence of the lesion, becoming progressively hyperfluorescent with a leakage on the late phase. The ICG disclosed an early hypofluorescence of the macular lesion with a mild staining of its periphery on the late frames. Hypofluorescent satellite lesions were visible both on the early and late frames. The OCT disclosed a serous retinal detachment at the level of the whitish lesion. Serologies for Bartonella henselae (BH) became positive (IgG 1: 512, IgM < 1:20) confirming an active or recent infection. CONCLUSIONS: Ocular manifestations of CSD can appear as a UAM with satellite lesions. CSD should be ruled out in patients manifesting such clinical features.

Pasteurella multocida endophthalmitis: case report and review of the literature.

BACKGROUND: Postoperative bacterial endophthalmitis is caused by the patient's endogenous flora in most cases (80 %). Pasteurella multocida (PM) is a Gram-negative coccobacillus found in the upper respiratory tract of dogs and cats and is very rarely implicated in postoperative endophthalmitis. HISTORY AND SIGNS: We describe a case of PM endophthalmitis that developed after cataract surgery. THERAPY AND OUTCOME: Cultures of both the conjunctiva and the aqueous humor were positive for PM. Topical, intravitreous and intravenous antibiotics were administered. Despite treatment, the outcome was unfavourable and complicated by a corneal perforation. CONCLUSIONS: The prognosis of postoperative PM endophthalmitis remains poor, despite adequate treatment of the infection. A history of recent pet exposure should alert physicians to this possible aetiological factor.

Varicella-zoster virus retinitis: successful evolution with a combination of antiviral therapies.

BACKGROUND: We present the description of a successful outcome in a case of varicella-zoster virus (VZV) acute retinal necrosis (ARN). HISTORY AND SIGNS: A healthy 40-year-old patient was admitted for a VZV retinitis. THERAPY AND OUTCOME: 10 days after the onset of intravenous (i. v.) acyclovir treatment, new small peripheral retinal necrotic lesions appeared in the right eye. A viral resistance was suspected and the acyclovir therapy was optimised with i. v. foscarnet combined with 2 intravitreal injections of ganciclovir. The outcome was favourable with a final vision of 1.0 after a follow-up of 30 months. No systemic or local complications were observed. CONCLUSIONS: VZV ARN is a severe infection with a poor prognosis. This case demonstrates that combination of antiviral therapies given intravenously (acyclovir + foscarnet) and in the vitreous (ganciclovir) may be safe and efficacious in the management of necrotising herpetic retinopathies affecting immunocompetent patients.

[Endogenous fungal endophthalmitis: results of antifungal treatment with and without vitrectomy]. / Endophtalmies fongiques endogènes: résultats après traitement anti-mycosique associé ou non à une vitrectomie.

BACKGROUND: Fungal endophthalmitis represents a significant cause of ocular morbidity, affecting in the majority of cases patients in poor general conditions. The eye is typically involved by hematogen dissemination, and the germ induces a chorioretinitis associated with an important panuveitis. PATIENTS AND METHODS: Four patients were examined. They complained of a progressive reduction of vision, associated with photophobia. Ophthalmologic examination disclosed an important panuveitis. Investigations showed a fungal chorio-retinitis in all cases. Risk factors were intra-venous toxicomania, longterm parenteral nutrition and traumatism of the sinuses. RESULTS: Vitreous cultures were positive for Candida albicans (3 patients) and for Aspergillus fumigatus (1 patient). Blood cultures were negative in the four cases. Three patients were treated with anti-fungal medication (fluconazole, itraconazole) associated with a vitrectomy by pars plana. One patient was treated by anti-fungal therapy only. Clinical evolution was satisfactory in all cases. Final vision was 10/10 in three cases and 5/10 in one. One patient developed a retinal detachment and an epiretinal membrane. Follow-up was 7 months (2-16 months). CONCLUSION: The evolution of these four cases suggests that a rapid anti-fungal therapy associated with or without a vitrectomy represent a favourable therapeutic option when a fungal infection is suspected.

Acute intraoperative suprachoroidal haemorrhage in ocular surgery.

PURPOSE/BACKGROUND: Acute intraoperative suprachoroidal haemorrhage (AISH) is the most sight-threatening complication of ocular surgery. We investigated the visual outcomes following this intraoperative event, patient characteristics that may predispose to it and the clinical features that may be of prognostic significance. METHODS: The records of 45 cases of AISH collected from ophthalmic centres in the United Kingdom, Republic of Ireland and Switzerland were reviewed. Two satisfactory controls in terms of operative procedure, surgeon, age (+/- 5 years) and gender were found for each of 33 of our cases. Systemic and ocular characteristics were compared for cases and controls, and the visual results of all cases of AISH are analysed. RESULTS: Cases and controls differed only in terms of axial length and pre-operative intraocular pressure, both of which were significantly greater for eyes that experienced an AISH (p < 0.05). Ten eyes (22.2%) achieved a final Snellen acuity of 6/12 or better. Statistically significant associations with a final acuity of counting fingers or worse included spontaneous nuclear expression (p = 0.02), retinal detachment (p < 0.0001), four-quadrant suprachoroidal haemorrhage (p = 0.007) and vision of perception of light or worse at the first dressing (p = 0.0001). Four of the 6 eyes that experienced an AISH during phacoemulsification surgery had a visual outcome of 6/12 or better, and this was significantly greater than for cases involving extracapsular cataract surgery (p = 0.004). CONCLUSION: The results indicate that longer axial length and higher pre-operative intraocular pressure are associated with increased risk of AISH. Poor visual results are more likely following spontaneous nuclear expression, retinal detachment, four-quadrant suprachoroidal haemorrhage or vision of perception of light or worse at the first dressing. The results also suggest that AISH complicating a phacoemulsification procedure has a more favourable visual prognosis than AISH that occurs during extracapsular cataract surgery.

Colour vision in AIDS patients without HIV retinopathy.

Patients suffering from AIDS develop ocular complications, the most frequent being HIV retinopathy. It is however not clear, if functional visual impairments can be observed as early indicators of ocular complications, before clinical diagnosis of HIV retinopathy is made at fundus examination. To address this issue, we measured colour vision in a group of 49 AIDS subjects with normal clinical fundi using the 'two equation method'. This method, combining red-green Rayleigh and the blue-green Moreland metameric matches, enables more complete and quantitative assessments of colour vision than those based on pigmentary tests. Data were collected on our computer controlled colorimeter and compared to those of normal subjects. While most AIDS subjects without HIV retinopathy demonstrated normal colour vision, a significant portion of them had wider matches than normal subjects (11% for the Rayleigh equation and 16% for the Moreland equation). Furthermore, matching ranges of the Moreland equation were significantly correlated with CD4 lymphocyte counts. Patients with low CD4 values tended to produce larger matching ranges than the patients with high CD4 values. A within subject study on 17 patients confirmed this trend and showed that the patients who increased/decreased their CD4 blood counts generally improved/impaired their colour discrimination in the Moreland match. No such correlation was found between the matching ranges of the Rayleigh equation and the CD4 counts. These results show that colour discrimination is slightly reduced in some AIDS subjects, although there are no detectable ocular complications. They also suggest two different types of colour vision impairments in AIDS patients without retinopathy: one reversible process affecting colour discrimination in the blue-green range; and another irreversible process affecting colour discrimination in the red-green range.

Thrombus and branch retinal vein occlusion.

Branch retinal vein occlusion (BRVO) is often associated with arteriosclerosis. Typically the occlusion occurs at an arteriovenous crossing. We report a case of a previously healthy patient who developed a BRVO. Funduscopy and fluorescein angiography suggested an intravascular thrombus as the cause of the occlusion. The investigations performed were positive for systemic hypertension and hyperlipidaemia. After 2 months, fundus examination revealed disappearance of the intravascular thrombus, resolution of the macular edema and improvement of the visual acuity. Certain physiological characteristics of the retinal circulation associated with hyperlipidaemia and systemic hypertension appear to favour thrombus formation.

Multiple evanescent white dot syndrome after hepatitis B vaccine.

PURPOSE: Hepatitis B vaccine has become an effective means of preventing complications of hepatitis B. However, it occasionally induces serious side effects. We report a case of multiple evanescent white dot syndrome (MEWDS) that occurred following hepatitis B vaccination. METHODS: A 23-year-old woman with a one-week history of progressive loss of vision in the left eye and bilateral photopsia was referred for examination. Her symptoms appeared 24 hours after a booster intramuscular injection of hepatitis B vaccine. RESULTS: Clinical examination, fluorescein angiography, and the course of events were typical of MEWDS. CONCLUSIONS: This case demonstrates the occasional occurrence of MEWDS after hepatitis B vaccine and suggests that hepatitis B virus immunization may be a risk factor for this retinal condition.

Presumed bilateral cytomegalovirus-induced optic neuropathy in an immunocompetent person. A case report.

Ocular manifestations of an acquired cytomegalovirus (CMV) infection are often associated with the patient being in an immunocompromised state. In the vast majority of cases, the affliction appears as a necrotic retinitis; an isolated optic nerve lesion is seen less frequently. To date, only two cases of CMV retinitis and one case of bilateral acute retinal necrosis have been reported in healthy individuals. We describe a 32-year-old healthy woman who developed bilateral papillitis. Tests were positive for acute CMV infection but negative for an immunocompromised state. We changed the antiviral therapy from acyclovir to foscarnet in association with corticosteroids, and resolution of the papillitis and recovery of visual acuity were obtained.